Behind the Scenes with an Oral Health Advocate

For Pareesa Charmchi Goodwin, hearing people’s stories, hearing how she can help, is a gift.

“I am fortunate to have built relationships with community leaders and people we advocate for,” she says. “I am honored and humbled when people trust us with their stories and ask for advice on navigating the system. And unfortunately, there is no shortage of these stories.”

Goodwin is the executive director at the Connecticut Oral Health Initiative (COHI), a 501(c)(3) nonprofit that advocates for oral health access, equity, and quality though policy change. COHI prioritizes the perspectives of directly impacted communities — i.e., minoritized and underserved communities — and works in close partnership with provider associations and oral health stakeholders.

“But we are not a traditional oral health coalition,” Goodwin says. “We are clear that we advocate for the public and prioritize the concerns of communities that experience disproportionate levels of adverse oral health outcomes and do not have consistent access to quality oral health services.”

Goodwin and hundreds of oral health advocates like her around the country are continually working behind the scenes to improve the oral health system. She will share some of the lessons learned during the April 21 CareQuest Institute webinar, “Community-Centered Grantmaking: Why, How, and What Lies Ahead.” Leaders from the CareQuest Institute grantmaking team and Jennifer Goldberg, JD, a deputy director at Justice in Aging will also discuss the historical power imbalances in oral health and the urgent need for systems-change solutions.

A glimpse into Goodwin’s work provides a snapshot of the challenges and successes many advocates see every day.

Goals and Recent Accomplishments

“I am proud of the community engagement practices we have built and continue to hone,” Goodwin says. “We are building on our long-standing relationships with community leaders to reach adults on Medicaid, gather their perspectives, and shape our policy agendas and priorities based on community feedback.”

In 2022, those priorities for COHI include:

• Increase the dental reimbursement rates for adults to expand provider participation in the HUSKY program and the acceptance of adults on HUSKY as patients.
• Increase access to care by developing a dental therapy workforce.
• Close gaps in Medicaid dental coverage, including covering periodontal services, two cleanings per year, and the use of silver diamine fluoride.
• Determine the impact of the annual maximum benefit policy on adult dental Medicaid.
• Build support for — and advocate for — the state to capture dental claims in the all-payors claims database. Promote the inclusion of oral health inclusion in the newly forming Health Information Exchange (HIE).

“We are also engaging interested individuals and groups in advocacy to address the problems they identify,” Goodwin says. “We help people identify and contact their legislators, testify at public hearings, and track legislative proposals, for example.”

In the past three years, Goodwin points to some important policy gains:

• a 25% increase in the Medicaid adult dental reimbursement rates and an additional increase for adult dental endodontic services (pending Connecticut state budget approval in May)
• a second cleaning for adults on Medicaid who have chronic conditions or are pregnant
  • Adults on Medicaid in Connecticut are otherwise limited to one cleaning a year
• a public act that allows dependents up to age 26 to keep their family dental coverage — just as they can health/medical insurance
• authorization of dental therapy

“We have much to do to implement dental therapy,” adds Goodwin, “including making changes to the statute to establish a license and removing unnecessary barriers to developing the workforce.”

A Day in the Life of an Oral Health Advocate

There’s no “average day” for an advocate. Instead, it’s a mix of activities depending on the time of the year.

“There are always lots of phone and video calls (since the pandemic) with oral health stakeholders throughout the state, including provider associations, state agencies, as well as health/poverty alleviation/social justice advocates, and direct service providers,” says Goodwin. “We work hard to reach community leaders and families in rural areas and cities, faith groups, people who are experiencing economic insecurity.”

In the spring, during the legislative session, the calendar is filled with testifying at public hearings, getting others to testify at hearings, speaking with legislators and state agency staff, and speaking at press events with partners. There’s also frequent and ongoing coordination with other health and social justice advocates, such as the HUSKY 4 Immigrants Coalition and Medicaid Strategy Group, to move the needle on issues through coordinated advocacy campaigns and contribute unique and invaluable oral health perspectives and knowledge.

Throughout the year, Goodwin meets with researchers and partners on projects like the Medicaid Gap Analysis. She also sits on multiple state advisory bodies where she aims to (1) advance oral health access, equity, and quality and (2) elevate community voice. And always, the team is fielding calls from people who are having difficulty finding a provider or navigating the dental care system.

“Mostly we hear from people on Medicaid, people with special health care needs (or parents of children with special health care needs, people who are undocumented and not eligible for public insurance,” Goodwin says.

Like everyone, the work has looked different during the pandemic — but it led to some positive changes, too.

“We had to shift our community and stakeholder engagement, partner and team meetings, and advocacy from in-person to virtual engagement,” Goodwin says. “This was a difficult shift in some ways (e.g., some communities lack good broadband access), but we were able to continue a lot of the work that we do and even develop a deeper community engagement strategy during the past year.”

The shift toward virtual communication and engagement also alleviated transportation and childcare coordination barriers to participation.

Hope for the Future

What’s next for Goodwin and COHI?

Along with the coming legislative sessions, the focus on their six key priorities will keep them busy in 2022. And if Goodwin could wave a magic wand?

“Comprehensive oral health services would be an essential component of health coverage for all ages,” she says. “This would do wonders for access, as coverage and affordability are key components of access, and it would do wonders culturally. Oral health is treated as an ‘optional benefit.’ This undermines the importance of oral health and makes it difficult to secure additional funds for oral health or fend off budget cuts.”

In the meantime, she and the team will be answering calls and sharing resources, including information on the state’s Medicaid program, and guiding people toward community health centers and other safety net options in local communities.

“I stay grounded by staying close to community and anchoring myself in their experiences,” Goodwin says. “There is a lot of work to do in the way of oral health access and equity in Connecticut.”

Editor’s Note: To hear more from Goodwin, check out the April 21 CareQuest Institute webinar, “Community-Centered Grantmaking: Why, How, and What Lies Ahead.”