Did you know that AGD tracks oral health-related legislation being introduced in state legislatures across the United States? AGD Advocacy closely monitors these activities while working with constituent leaders by providing resources and analysis on the impact of these policies as well as assessing any opportunity for advocacy efforts.

Members involved with AGD’s advocacy efforts spend time educating their legislators on the impact the bills that are being introduced would have on patient care if passed. For example, Florida AGD members have been actively watching a dental therapy bill introduced in the Florida State Senate and have already taken action by sending letters and meeting with their legislators on this issue. Recently, S.B. 152 was temporarily delayed at the committee level for the second time after being placed on the agenda for a public hearing. 

Below is a list of state legislative updates reflecting nationwide trends. Knowing what’s happening in other parts of the country will help you prepare should similar issues arise in your state. While this list does not include all of the issues AGD is tracking, it highlights some that we believe will be useful for members to familiarize themselves with as they prepare to advocate for oral healthcare.

Dental Therapy

Currently, eight states (Arizona, Connecticut, Maine, Michigan, Minnesota, Nevada, New Mexico and Vermont) have enacted laws that authorize the licensure and practice of dental therapists. Dental therapists are oral health midlevel practitioners able to perform surgical and irreversible procedures, oftentimes after completing a two- to three-year postsecondary educational program. Minnesota is currently the only state with active practicing dental therapists after being the first state to pass such legislation in 2009. 

Four other states (Alaska, Idaho, Oregon and Washington) allow for dental health aide therapists (DHATs), which are oral health midlevel practitioners limited to practicing on federally recognized tribal land and on members of federally recognized tribes. Federal law requires state legislatures to implement such services upon the request of an Indian tribe or tribal organization. 

Below is a list of states that have introduced dental therapy bills this legislative session:

• Florida introduced S.B. 152 in August 2019, and the bill has been “temporarily postponed” in committee twice in February 2020, meaning that the bill was on the committee agenda for a hearing and would then receive a vote by committee members, but — for unknown reasons — the bill was stricken from the agenda at the last minute. This same situation led to the bill’s failure in last year’s session.
• Oregon introduced S.B. 1549 at the beginning of its “short session” on Feb. 3, 2020. A public hearing was held the next day, as Oregon’s legislative session during even-numbered years lasts only 35 days (hence “short session”). Additionally, the committee held two work sessions, where only invited members are in attendance to discuss amendments for the bill. During the second work session on February 13, no further amendments were discussed, and the committee decided to discontinue efforts on the bill this session. Oregon is one of the four states that allow for the licensure of DHATs and is the only state participating in a DHAT pilot program established in 2016.
• Hawaii introduced H.B. 1806 and referred the bill to committees in January 2020. The bill has since remained inactive and has yet to be scheduled for a public hearing.
• Washington reintroduced last session’s S.H.B. 1317 in January 2020. Last session, the bill made it through the committee process with amendments but never made it to the House floor to receive a vote by the full chamber. Currently, the bill is waiting to be placed on the House floor calendar where it may receive amendments and a vote by the full chamber. Washington is also one of the four states to allow for the practice of DHATs after passing legislation in 2017.
• Wisconsin A.B. 81 and Senate companion bill S.B. 89 were introduced in March 2019. Each chamber held hearings within their referred committees in August and December 2019, respectively, but neither committee has taken executive action on the bill. In order for the bill to be considered by each full chamber, the committees must cast a majority vote recommending it for passage.  
• Massachusetts currently has two separate bills that call for dental therapists, S. 1215 and H. 4134. The main purpose of S. 1215 is to establish requirements for the licensure and practice of dental therapists. After being introduced in January 2019, the bill was heard in May 2019 by its original committee, which then discharged it to the Committee on Health Care Financing in August. The new committee must make a recommendation on the bill before it can move forward, but, so far, no action has been taken. H. 4134 was introduced in October 2019 by Gov. Charlie Baker and covers a wide range of healthcare-related issues. One of these includes language to authorize dental therapists in the state. A hearing was held for the bill in January 2020, but no action has been taken since. 
  

Fluoridation

Legislation regarding community water fluoridation continues to be a debated issue at both the state and federal levels. Though the fluoridation of water systems has been proven to be safe and effective in preventing cavities with over 70 years of research, some states and municipalities are still considering the elimination of fluoride in public water due to lack of funding, burdensome maintenance or theories regarding fluoride’s potential health risks. Please see highlights below of legislation currently being watched by AGD Advocacy:

• Hawaii introduced S.B. 2732 and referred it to committees in January 2020. This legislation would prohibit water systems from introducing fluoridation and specifically cites studies claiming fluoride as neurotoxic, such as that of the National Toxicology Program. No further action has been taken on the bill. 
• Contrary to the legislation above, Hawaii also introduced S.B. 2997 in January 2020, which would require any public, private or government-owned water supplier to adjust and maintain optimal fluoride levels as determined by the U.S. Department of Health and Human Services. The bill was heard by committee on Feb. 7, 2020, and has since been deferred.
• New Jersey introduced S. 997 in January 2020 to support the oral health of state residents by mandating community water fluoridation. The legislation would require all public water systems to comply within 12 months of its effective date, though no action has been taken since its introduction. 
• Massachusetts introduced H. 2529 in January 2019, which is a pro-oral health bill with the main intent of imposing a sugary drink tax to promote healthy alternatives for state residents. Additionally, the legislation establishes a municipal grant program to support the fluoridation of public water supplies. A hearing was held for the bill in May 2019, but there has been no action since. 
• Kentucky S.B. 86 and Mississippi S.B. 2071 were introduced in January and February 2020, respectively. Both bills would allow local governments to discontinue the fluoridation of their water systems and opt out of statewide requirements. Neither has been scheduled for further action.  

Access to Care/Medicaid

• Oregon H.B. 4127 and Illinois S.B. 2520 both establish school-based dental programs, with H.B. 4127 also requiring school districts to include oral health in their education curriculums. S.B. 2520 was recently introduced and assigned to committees on Feb. 4, 2020, and H.B. 4127 was heard by committee on Feb. 3, 2020.
• Several states have bills related to expanding dental benefits for Medicaid recipients in some form, including Wisconsin A.B. 680/S.B. 636, Kansas S.B. 349, Hawaii H.B. 2249/S.B. 2459, Arizona H.B. 2535 and West Virginia S.B. 648. The expansion of current state dental benefits could include providing adult services, expanding adult services beyond emergency care only, or expanding services for certain vulnerable populations such as patients with disabilities, patients with diabetes or patients who are pregnant. 

Visit the AGD Advocacy page for more information about efforts at the state and federal levels. If you have questions about a specific state bill or issue, including any not listed above, contact Ninia Linero, coordinator, government relations. For information on activities at the federal level, contact Michael Toner, manager, government relations. 

If you are interested in connecting with other AGD members on advocacy and legislative issues, you may be interested in joining AGD’s Advocacy Community. Members use this community to exchange information, network and discuss issues. To request to be added, email agdconnect@agd.org.