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ADA requests $199 million for Indian Health Service in FY 2019

May 09, 2018

By Jennifer Garvin

Joseph P. Crowley
Hearing: ADA President Joseph P. Crowley testifies before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies on May 9.

Washington — The ADA testified May 9 before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies to request $199 million in funding for the Indian Health Service Division of Oral Health to help “aggressively reduce” the level of oral disease in Indian Country.

ADA President Joseph P. Crowley, who spoke on behalf of the Association, thanked the committee for its support and urged the lawmakers to prioritize the oral health of American Indians and Alaska Natives for fiscal year 2019.

“You were strong backers of the IHS dental program’s Early Childhood Caries initiative, which aimed to reduce tooth decay among children under the age of 5,” he said. “Through this program, the IHS has been able to significantly increase prevention and early intervention for these children.”

 Dr. Crowley shared the following numbers from the 2009-2017 IHS Early Childhood Caries initiative:

  • Dental sealants usage increased by 65 percent.
  • The number of children receiving fluoride varnish increased by more than 68 percent.
  • The number of therapeutic fillings increased by 16 percent.

But despite this progress, “more is needed to overcome the disparity of oral disease in tribal communities,” he said.

Dr. Crowley pointed out that more than 80 percent of American Indian/Alaska Native children ages 6-to-9 and 13- to 15-years-old suffer from dental caries compared to less than 50 percent of the rest of the U.S. population in the same age groups.

The ADA also asked the committee to increase the IHS dental budget for clinical services, calling the current proposed increase of $1.7 million an “unrealistic request.”

“In 2017, the IHS dental program provided over 3 million basic dental services in 404 dental programs in 35 states,” Dr. Crowley said. “The Administration’s current request would be less than a dollar per visit. The ADA recommends that the IHS dental clinical services line be increased by at least $3 million.”

The ADA applauded IHS for its dentist recruitment efforts that focus on placing dental students in extern programs, noting that in 2016, 115 students were placed in 23 different sites. However, despite that success, the IHS dental vacancy rate currently hovers around 20 percent because there isn’t enough loan repayment funding.

“In 2017, 788 providers including 18 dentists were turned down for loan repayment,” Dr. Crowley said. “[IHS] estimates that it would take an additional $39 million to meet these requests. We strongly encourage the committee to fully fund this program to ensure that all interested health care providers can serve in the IHS.”

Also in his testimony, Dr. Crowley said the ADA “is pleased that IHS is making progress on developing a centralized credentialing system” and thanked the committee for supporting that effort.

“It is our understanding that the credentialing software has been implemented across all IHS direct service areas,” he said. “This will streamline the credentialing process and help fill dental vacancies with quality health care professionals in a timely, efficient manner. Expansive but secure credentialing would also allow private dentists to provide care in a timely manner.” 

Dr. Crowley concluded by saying the ADA “strongly opposes” the Administration’s proposal to eliminate funding for Community Health Representatives. The Association is currently working with the Navajo Community Health Representatives Outreach Program to educate Navajo Community Health Representatives and dental assistants about the ADA’s Community Dental Health Coordinator position. The ADA has invested $7 million dollars in the development and expansion of the CDHC program to enable greater community outreach, community oral health education and preventive services.

“Most CDHCs grew up in the communities they serve, allowing them, through cultural competence, to better understand the problems that limit access to dental care,” said Dr. Crowley, who added there are currently 16 CDHCs working in tribal facilities including the Chickasaw and Navajo communities in Oklahoma and Arizona. Follow all of the ADA’s advocacy efforts at