Connecting Low-Income Children To Dental Care: An Innovative Partnership In Washington State

By Vanetta Abdellatif and Kimberly Craven, DDS | May 21, 2020

What comes to mind when you hear the letters A, B, C, and D? Singing the alphabet song? Babies? Early childhood programs?

For Arcora Foundation and our partners, ABCD means Access to Baby and Child Dentistry, a system of care that for more than 20 years has connected Washington State’s Medicaid-enrolled children under age six with dental care in their local communities. Arcora Foundation has been a proud supporter and funder of ABCD for nearly as long as we’ve been a foundation. We have invested more than $6 million, and tens of thousands of hours of staff time and resources, in the program. Why? Because ABCD has local roots, serves Washington State’s communities in different ways based on their demographics and needs, and because ABCD works.

As a result of ABCD, in 2018, 55 percent of Medicaid children under age six accessed dental care—making Washington a national leader in the percentage of these young children receiving such care. According to the Centers for Medicare and Medicaid Services, in 2018 only 38 percent of Medicaid children under age six received a dental visit. In 2020, Washington’s legislators again voiced their support for the program, with plans for expanding ABCD program funding to serve more children of color, ages 0–2, and to serve children with special health care needs up to age thirteen. However, the state faces significant financial hurdles because of the COVID-19 crisis, and the additional funding may be in jeopardy. In the words of an ABCD parent, “ABCD is a really wonderful program and makes regular family dentists accessible to children in low-income families. I’m so happy that we could stop the decay before it became a bigger problem.”

National Recognition

ABCD has garnered widespread support because it has been successful—so successful, in fact, that it’s been replicated nationally, named a best practice by the American Academy of Pediatric Dentistry, called by Pew’s Center on the States a proven strategy that can help policy makers deliver a strong return on taxpayers’ investment, and recognized by the W.K. Kellogg Foundation, the Children’s Defense Fund, and other organizations.

Keys To ABCD’s Success

People often ask: what is the key to ABCD’s success? The answer: there isn’t just one.

First, ABCD is led and supported by a state-level public–private partnership, and each partner organization has specific expertise and influence that contributes to the program’s sustainability and success. Without this partnership and each partner’s unique contributions, ABCD wouldn’t exist, let alone serve so many young children and enjoy the participation of so many dental providers.

Partners such as the University of Washington School of Dentistry (UWSOD) and the Washington State Dental Association promote ABCD to dentists, and in the case of UWSOD, it trains and certifies them to participate in the program. Partners such as the Washington State Department of Health and the Health Care Authority (Washington’s Medicaid Program) align and implement policies that support ABCD. For example, ABCD dentists receive enhanced fees, and the 25 local ABCD programs receive state and federal match funding to provide outreach and help clients to make and keep dental appointments. Arcora Foundation, the philanthropic partner and a 501(c)4, advocates for legislative support and funding and recently lobbied for the ABCD expansion. Arcora Foundation also provides additional funding for local programs as well as funds for the salary of a statewide ABCD director, who provides leadership and support to the statewide public–private partnership, local programs, and providers.

Second, ABCD is successful today because it could be tailored to fit the needs of individual counties when they were ready to implement the program. ABCD’s expansion from one Washington county to a system of care serving all of Washington’s 39 counties took nearly 20 years. Arcora Foundation, along with the other members of the public–private partnership, were willing to make long-term investments of time and money to ensure that individual counties were ready for ABCD rather than forcing a regional or statewide startup of the program on a specific timeline. Arcora Foundation and partners recognized that each county was unique and would only be successful in implementing an ABCD program when local partners and providers were ready. In the past two decades, Arcora Foundation provided ABCD start-up grants only when counties had demonstrated sufficient capacity to initiate and sustain a program.

Additionally, Arcora Foundation monitored the legislative environment and led the charge to protect ABCD whenever program funding was threatened. This constant, consistent investment of time and money ensured that focus, funding, and support remained—and still remains—for this essential system of care.

Third, ABCD is successful because the system can be adapted to meet the changing needs of patients, providers, and local programs. For example, as Washington State’s demographics have shifted, so have ABCD programs’ client outreach and engagement strategies. As technology has advanced, ABCD has begun to integrate tools like DentistLink, an online dental referral tool, funded and developed by Arcora Foundation, into its system of care. ABCD has also been used as a model to develop new systems of care to connect special populations, including those who are diabetic and/or pregnant.

The Data Validate ABCD’s Role

Finally, more than 20 years of data demonstrate that ABCD works. Having good data makes it possible to build and sustain the support of partners and policy makers and engage a variety of advocates to broaden the voices speaking out about the value of oral health. Largely because of ABCD, 55 percent of Washington’s Medicaid-insured children under age six accessed dental care in 2018 compared to 19 percent when the program began in 1995. The results are equally impressive for children under age two.

At the same time, the program continues to shift the focus and dollars from treatment to prevention. Untreated decay among low-income preschoolers in Washington State has dropped by one-third since 2005. And today, ABCD serves more than 178,000 children annually, and an estimated 875,000 children have received dental care since the program began.

Past Challenges Met

Has ABCD experienced challenges in its more than 20 years? Most definitely. There were times when the program’s funding was threatened—during the 2008 recession, for example. There were times when partners’ capacities to participate in the program were diminished because of budget cuts or leadership changes. There were times when local ABCD programs were unable to continue operating because of local funding challenges or shifts in priorities.

Given the ever-changing environment, ABCD will face challenges again—likely in the very near future. COVID-19 has stressed and will stress the dental delivery system. It may be more challenging for dentists, who are already feeling the financial impacts of COVID-19, to serve Medicaid patients. It may be more challenging for low-income families to make time to visit the dentist. There may be other disruptions or impediments that are unknown at this time.

However, ABCD strengths—the robust public–private partnership, the statewide system that can meet local communities’ needs, the ability of ABCD to adapt to changes in the environment, and the data that show that ABCD successfully connects kids with care—will ensure it serves Washington’s Medicaid-enrolled children and families for another 20 years, and, we expect, beyond.