Nearly 12 years ago, a nonprofit focused on substance abuse prevention in Lyon County, Nevada, expanded its services into dental care.
Leaders of the Healthy Communities Coalition rallied in shock after two of their food supply volunteers used forceps to pull on each other’s abscesses. The volunteers saw no other option to relieve their overwhelming pain in the small town where they lived, 40 miles southeast of Reno, due to a lack of dental care providers.
That drastic act, said Wendy Madson, coalition executive director, led her organization to use mobile clinics to provide health and dental services in rural communities where there aren’t enough patients to support brick-and-mortar offices.
The coalition now sends a van equipped with dental equipment to provincial schools to treat hundreds of students per stop a few times a year. They also organize events that provide free care to adults in the region. The response is overwhelming.
“Dental is the hot ticket,” Madson said. “Everyone wants dentistry. Availability of those services is what runs out first at those big mobile events.”
The coalition’s mobile programs reflect nationwide efforts to direct services to patients experiencing gaps in the healthcare system, especially in rural areas.
Rural residents face greater shortages of healthcare providers, including dentists, compared to their counterparts in larger cities. Since the start of the pandemic, mobile clinics have increased access to a range of services in hard-to-reach, sparsely populated areas.
A recently passed law making it easier for rural communities to pay for new mobile clinics could reinforce this trend. In the past, clinics serving low-income rural residents couldn’t spend federal grant money — called new access point grants — on mobile service in communities where they didn’t already have facilities.
Last fall, Congress passed the MOBILE Health Care Act, sponsored by Sens. Jacky Rosen, D-Nev., and Susan Collins, R-Maine, which gives federally qualified health centers — health clinics serving medically underserved areas — more flexibility to use federal funding to create and operate mobile units.
According to the National Association of Community Health Centers, the number of mobile clinics on the road has increased since 2019. Many were used for COVID-19 testing and vaccinations. And health and community organizations began using mobile units to provide primary care, behavioral health and reproductive services to remote patients. The new funding pathway could soon put even more mobile health vehicles on the road.
For now, the law depends on congressional funding, and experts predict it could take at least a year for health centers to access the grant money.
Freed from physical requirements, health centers can roll out the vans
Once funded, the regulatory shift will allow health centers to partner with independent organizations such as Nevada’s Madson’s Health Communities Coalition to expand services in underserved regions. Because the Coalition is not a federally qualified health center, it has relied on a mix of other federal and state grants.
Nearly 1,400 federally qualified health centers across the country receive federal funding to provide comprehensive health services in underserved areas. The previous requirement that health centers set up brick-and-mortar clinics before expanding mobile clinics prevented many from signing up, said Steve Messinger, policy director for the Nevada Primary Care Association. It was cumbersome and costly for health centers.
But in rural areas with a small population, well served by mobile clinics, it wouldn’t make sense to establish a building with a full-time provider first, he said. That could eat up the budget of a federally qualified health center.
While the health center lobbies Congress for grassroots funding, the Healthy Communities Coalition is moving forward with three dental events this year funded by a grant from the Health Resources and Services Administration, part of the Department of Health and Human Services.
At the coalition’s first medical outreach event in 2012 in Lyon County, which has 61,400 residents spread over more than 2,000 square miles, more than 200 people showed up to receive free care and 150 teeth were extracted, Madson said. Since then, the organization has hosted several events per year, except in 2020 when the pandemic halted work.
Many of the dental events are school-oriented and provide children with services such as screenings, x-rays, seals, varnishes, and cleanings. But there is also an overwhelming need for care among adults in the area, Madson said, because Medicare and Nevada’s Medicaid don’t include comprehensive adult dental coverage. It’s harder to fund those events, she said.
At least one of the five communities in Lyon County, Silver Springs, has no dentist. There are a total of 10 dentists in Fernley and Dayton, communities with a total population of 38,600 people, but only two of those practices accept Medicaid, which covers low-income people under the age of 21, and limited adult dental services.
Fulfilling a desperate need for dental and health services
Traci Rothman, who manages the coalition’s food supply, said the dental outreach events have made a difference for her 29-year-old son, who moved to Silver Springs last year. He went to two mobile clinics to receive free care, which Rothman said was a great relief because he is uninsured and in dire need of dental care.
“Otherwise you go to someone who pays you in cash,” she said. “Many times I honestly can’t afford it; it’s just out of reach for some people, or most people … in rural areas.”
Madson said the coalition stepped in to help a young student in dire need of a root canal. The coalition is helping the girl’s family apply for Medicaid or Nevada Check Up, the state’s childhood health insurance program, and is paying $1,600 to cover the service with federal grant money. Another student had to be referred to several specialists before having her decayed baby teeth surgically removed and receiving restorative treatment for adult teeth that had begun to decay.
“Her mom was so grateful, she was in tears,” Madson said. “She told me her daughter woke up without pain for the first time in years.”
Madson said her organization has enough funding for three events through May, but she hopes the MOBILE Health Care Act will help expand services. In addition to dental care, the group provides primary care mobile clinics for migrant workers in Yerington, a small agricultural town about 70 miles southeast of Reno.
Sara Rich, CEO of Choptank Community Health in Maryland, said she shares Madson’s hopes.
Choptank serves five Maryland counties, including small towns between the Chesapeake Bay and the Delmarva Peninsula. Amid the pandemic, the health organization formed an unlikely partnership with a car dealership and used federal COVID relief money to purchase a Ford Transit van for mobile clinics.
Choptank used its new van to deliver vaccines, but has since started using it to provide primary care to migrant workers and dental services to children at 36 schools. The mobile clinics are so successful that the health center is in the process of purchasing more vans to expand its services.
Rich said the mobile clinics “break down barriers that many of us have been working on for a long time.”
Among the new services Choptank plans to provide are behavioral health, the prevention and treatment of substance use disorders and skin exams for people working on the Maryland coast.
“Flexibility has been a theme in recent years,” said Rich. “I think that with this MOBILE Care Act we can do even more about this in the future.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operational programmes KFF (Foundation Family Kaiser). KFF is an endowed non-profit organization that provides information on health issues to the nation.