Voices from the Field: Alex Sheff on Advocating Oral Health Care for All

Alex Sheff is co-director of policy and government relations at Health Care For All (HCFA), a consumer health advocacy organization that supports health justice in Massachusetts by working to promote health equity and ensure coverage and access for all. Since 2004, CareQuest Institute for Oral Health has helped fund HCFA’s critical work around oral health in the Commonwealth. With that support, in 2021 HCFA has been focusing on improving oral health integration, licensing dental therapists to increase access to care, establishing a commission to improve data collection and management, and continuing to defend the Medicaid adult dental benefit in the state.

We caught up with Alex to learn more about these initiatives and the daily work at HCFA as it helps consumers navigate the health care system and advocate for improvements within oral health.

Can you tell us more about Health Care For All’s work?

I would say our work really starts with our HelpLine, which takes about 20,000 calls a year from people who are trying either to get enrolled in health insurance or navigate their coverage. Some have transitioned to a new job, some have complicated immigration statuses, and others have coverage but aren’t sure how to utilize it or find a provider.

Our HelpLine takes calls all day, every day with more than half of the calls in Spanish and Portuguese. We’ve been trying very hard to expand to some other languages, like Haitian Creole, but we haven’t gotten there yet. We had to expand the HelpLine’s capacity in the pandemic and added two new bilingual counselors. HCFA’s policy and advocacy work are guided by the themes we hear from callers on the HelpLine. We understand individuals’ problems and then try to translate what [counselors] are hearing into policy solutions.

Can you give an example of oral health policy and advocacy work Health Care for All is focused on in 2021?

We’re working right now on a bill to establish an oral health special commission and needs assessment. It’s been more than 20 years since we’ve had one in Massachusetts. We think this is really a moment where we need to take a deeper look at the oral health needs in the state. We know there are challenges in access and care. And we know there’s a disproportionate impact on communities of color and low-income communities. We just don’t have a full picture of that impact by age, by geography, by disease burden, and that’s what this bill would do.

Within oral health, we’ve also been working on the 1115 Medicaid waiver proposal.

Can you talk about that Medicaid waiver?

Every five years, the state negotiates with the federal government to determine how the state’s whole Medicaid program is going to operate. In the last waiver, we fought really hard, thanks to CareQuest Institute’s support, to include an oral health quality measure that all of the Accountable Care Organizations (ACOs) that participate in the state’s program in the state had to adhere to. That was our big oral health win, which moves us toward more integration.

This year, we are advocating for a couple of different things. One is to require all primary care practices that participate in the ACO program to have a two-question oral health screener. They’re going to be required to assess how recently a patient has seen a dental provider or if a patient is experiencing mouth pain. Then the provider would have to do some follow-up to provide a pathway toward care.

How does having a partner like CareQuest Institute help you do this work?

Having a partner like CareQuest and having stable funding enable us to dedicate staff resources consistently, which makes a big difference. I’ll start there. The second thing is that CareQuest Institute is full of experts that help us do our work, sharing their knowledge, data information, presentations . . . it’s really a two-way street. I think it’s both of those things.

What’s unique about this work to improve oral health? What drives you and your team?

I’ll give you an anecdote. I have a friend who runs a community partner program that helps people with complex needs navigate care in the state. She asked me to speak at their advisory board meeting, and I started to talk about HCFA’s work, including getting the adult dental benefit fully restored in MassHealth last year. (That was a 10-year battle — getting coverage tooth by tooth, as we sometimes say.) I started to mention how we just got this adult dental benefit fully restored, how it now covers root canals and crowns. This person on the board call was like, “Really? That happened? That’s amazing! I had to go get this procedure, and they instead ended up having to pull the tooth. It was terrible!”

I almost never get that kind of response to policy changes. I just think it’s something so tangible, and it really hits home. Oral health is just such a huge deal for people, and I think that impact gets lost sometimes.

Can you say a little more about getting the adult dental benefit restored?

In the last recession in 2009, the state did not have the revenue and so they cut several programs, including MassHealth. One of the results was that the state eliminated most of the adult oral health benefit. So, over a 10-year period, HCFA and others worked to get different pieces of that adult oral health benefit restored. We helped restore periodontal services a couple years ago. Then finally, the last step was adding back in coverage for root canals and crowns last January.

Lastly, has the COVID-19 pandemic changed the work and the focus on oral health?

Oral health is connected to overall health — that is the bottom line. We talk a lot now in the context of COVID-19 about underlying chronic conditions and what it means. It means something different than it did a year and a half ago — it was bad then, and now it’s terrifying with the links conditions can have due to COVID-19 complications. People may be able to understand the connection between oral health and management of other chronic conditions in a different way now.

Editor’s note: Explore our application process to learn more about how to apply for a grant at CareQuest Institute.