Dental Care for Individuals with Intellectual and Developmental Disabilities in New York State
- Adrienne Anderson
- 39 minutes ago
- 54 min read
Issue Brief by Adrienne Anderson
PDF available here:
Key Takeaways
Oral health is foundational to overall health, yet dental care is siloed from the broader delivery system. Medicaid reimbursement rates cover only a fraction of dentists’ charges, which disincentivizes provider participation. Just one-third of New York dentists are enrolled in Medicaid, which limits meaningful access.
When routine dental care is unavailable, patients seek relief in acute care settings. These visits are costly and typically limited to pain management or antibiotics, failing to resolve underlying dental conditions and reinforcing inefficient patterns of care, especially within Medicaid.
Individuals with intellectual and developmental disabilities (IDD) face additional challenges: Elevated oral health risk and difficulty maintaining daily hygiene increase clinical need, while sensory sensitivities, communication challenges, and behavioral support needs may require longer visits or other accommodations.
New York’s 2024 Oral Health Needs Assessment found that disability status was the strongest predictor of high oral health need, ranking above geography, income, and insurance status.
In finding dental care for individuals with IDD, caregivers must identify dental practices that both accept Medicaid and are prepared to accommodate disability-related needs, navigate Office for People with Developmental Disabilities (OPWDD) eligibility, wait out long delays and coordinate cross-county travel, and communicate sensory and behavioral needs in advance.
The transition from pediatric to adult dentistry creates a pronounced “access cliff” for adolescents and young adults with IDD, and there is no formalized system to ensure continuity once pediatric care ends.
Limited disability-focused training among currently practicing clinicians, low Medicaid participation, sedation and anesthesia bottlenecks, and compressed scheduling models all inhibit access to care for individuals requiring longer or more complex visits.
New York State Medicaid has some meaningful but underutilized payment policies in place, including a 20 percent enhanced reimbursement rate for individuals with IDD, a dental case management billing code, coverage of silver diamine fluoride, and an observation visit code to support appointments that focus on patient acclimation and evaluation. Provider awareness, billing confidence, and data transparency around the use of these tools remain limited.
Several incremental interventions could materially improve access, including: adapting the “Dental Care Passport” model to standardize pre-visit planning and communication; consolidating and centralizing existing training and education materials for clinicians, billing staff, caregivers, and patients; strengthening medical-dental integration; and facilitating flexible clinical arrangements that allow dentists to periodically serve individuals in IDD-focused settings without taking on full administrative duties.
Improving oral health access for individuals with IDD does not require a single sweeping reform. Rather, it requires more awareness and utilization of available reimbursement enhancement, education and training on a range of topics for all involved stakeholders, and a more inclusive, flexible operational approach.
Part I: Overview of Dental Care and Oral Health
Oral health is a core component of overall health, with population-level gains driven largely by preventive public health interventions. As this is the Step Two Policy Project’s first publication focused exclusively on oral health, this Issue Brief begins with an overview of dental care delivery in Part I, then turns to the challenges facing individuals with intellectual and developmental disabilities (IDD) in Part II. Although many of these issues are common across the United States, this Brief focuses on New York.
The Brief concludes with a slate of recommendations to improve the accessibility and sustainability of oral and dental health services for the population with IDD. Despite the State’s recent efforts to enhance existing programs and services, meaningful opportunities continue to be overlooked. Funds and policy efforts would be well spent addressing some of the acute problems presented in this Issue Brief, which are either technical in nature or affect smaller populations that lack sufficient attention or commitment from a broad enough cohort of legislators and policymakers.
While NYS performs slightly better than the U.S. average on some measures, such as dental visits among the commercially insured and fluoridated water access, considerable access challenges persist, especially for Medicaid members. Only one-third of NYS dentists are enrolled as Medicaid/CHIP providers. Medicaid fee-for-service reimbursement rates cover dentists' charges at 30 cents on the dollar and pay 56% of commercial rates, on average.[i]
Access is further strained geographically: federally recognized Dental Care Health Professional Shortage Areas in New York have a percent-of-need-met of only 16.2%, with an estimated 588 additional dentists needed to close the gap. Taken together, these statistics reflect a system in which low reimbursement rates suppress provider participation in public programs, contributing to persistent shortages and access gaps — a phenomenon present throughout the country. These and other statistics are presented with national comparators in a table in the Relevant Statistics section.
Oral health and physical health are deeply interconnected. Untreated dental disease is associated with chronic pain, infection, cardiovascular disease, diabetes complications, adverse pregnancy outcomes, and avoidable hospitalizations. For many individuals, particularly those with complex medical conditions and disabilities, oral health problems can directly compromise their overall physical health.
Despite its clear clinical relevance, oral health has long occupied a marginal and siloed place in U.S. health policy. Adult dental care was excluded from the Affordable Care Act’s definition of essential health benefits, and many states offer only basic dental benefits in their Medicaid programs, leaving comprehensive coverage expensive, fragmented, and uneven across the population. As a result, disparities persist in access to dental services by income, geography, disability status, and insurance type.
When people cannot access preventive and routine dental care and are desperate for relief from oral abscesses or other sources of dental pain, they often resort to hospital emergency departments, which are ill-equipped to provide definitive treatment or address root causes. This acute care utilization drives higher system costs and does little to alleviate suffering and long-term risk for patients.
Professional Roles:[ii],[iii] General dentists are licensed clinicians with the broadest scope of practice in dentistry. Dentists complete at least a bachelor’s degree and a four-year dental school education, earning a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD), and must pass a national board exam and a clinical assessment. Some pursue additional training in any of 12 specialties recognized by the American Dental Association (ADA), such as pediatric, periodontology, and dental public health. They can diagnose and treat oral disease, perform restorative and surgical procedures, interpret diagnostic results, administer anesthetics, educate patients on oral health behaviors and nutrition, and manage oral injuries and emergencies.
Dental hygienists are clinicians who have completed a CODA (Commission on Dental Accreditation)-accredited program and passed national, regional, and state board examinations for licensure. They can screen for oral and dental disease, perform cleanings, educate patients on at-home oral hygiene, and apply preventive fluoride varnish and sealants. Dental assistants have at least a high school diploma or equivalent, complete a licensure-qualifying training program, typically at the Associate’s or Bachelor’s level, and pass a national certification exam. They take X-rays and impressions, assist with procedures, support infection control practices, and maintain patient records.
Scope of practice and licensure requirements for dental practitioners vary considerably by state. One factor contributing to the relative difficulty of practicing dentistry in New York State is that, since 2007, dentists have been required to complete at least one year of a dental residency program as a condition of licensure. In other states, dentists can be accepted for initial licensure upon passing the required exams. This pre-licensure dental residency requirement is thought to incentivize the outmigration of New York’s dental school graduates, who can earn income sooner by leaving the state. Considering the average dental school graduate has $312,000 in debt (and many carry additional undergraduate loans),[iv] the economic incentive to practice sooner rather than later cannot be overstated, especially if the dentist intends to practice in relatively lower-salary clinical settings, such as federally-qualified health centers.
As a point of comparison, medical graduates are required to complete residency programs prior to independent practice, but they are typically employed as salaried medical residents holding limited permits or training exemptions, and residency is coordinated to allocate applicants to limited numbers of slots across specialties nationwide. Most medical residency programs pay similar salaries,[v] so there is little incentive to seek placement out of state on the basis of immediate earning potential.
In December 2025, Governor Hochul signed legislation expanding “collaborative practice” for dental hygienists, effective June 19, 2027. Hygienists who are licensed and registered in New York, have at least three years of practice and 4,500 practice hours, and have completed an 8-hour continuing education program, will be able to apply to the State Education Department and pay the required fee to practice as a registered dental hygienist under collaborative practice. Qualified hygienists will be able to enter into collaborative practice agreements with licensed dentists to provide designated services under general supervision and without an on-site dentist. This is expected to improve access to care[vi] because collaborative practice dental hygienists will be able to treat patients through a broader range of community-based settings, including schools, federally qualified health centers, long-term care facilities, group homes serving individuals with intellectual and developmental disabilities, and other institutional or homebound settings. This policy initiative is a rare (and welcomed) exception to the general rule that proposals to broaden scope of practice usually die in the legislature.
Other efforts to expand scope of practice or create new clinical titles have fared less well, though advocates continue to make the case as opportunities arise. Prior legislative cycles in New York have included proposals to establish a mid-level oral health provider, a “dental therapist,” to expand access to routine dental services, which would be particularly helpful in already underserved areas. Dental therapy models authorized in 12 other states and 14 tribal jurisdictions[vii] use a task-shifting approach, common in public health interventions in other resource-constrained contexts, to allow clinicians with focused training to provide a limited set of preventive and basic restorative services under dentist supervision or collaborative practice. Dental therapists are trained to perform technical tasks and fill gaps in the clinical workflow, but depending on the setting, they can function with a broader role, managing patient care over time and over multiple appointments.
Proponents argue the dental therapy model could help address workforce constraints and geographic and payer-related access barriers in New York. Critics of dental therapy argue that the quality of services delivered by mid-level providers would be substandard and express concerns about the implications for the future role of dentists in leading the management of patient care. Proponents of these measures suggest the critics’ real concern is the reduction in compensation that might result from competition.
Ultimately, patient-centered reform of scope-of-practice laws and care delivery-related regulations will be essential to improving upon some of the conditions described in this Issue Brief.
Settings: Dental care is provided in a variety of settings, including federally qualified health centers (FQHCs), private offices, pediatric-focused clinics, including school-based clinics, and mobile and portable settings, which serve all ages. Each setting operates under different regulatory, financing, and workforce constraints, which shape both the services offered and the populations ultimately served. The availability and continuity of dental care often vary by geography, age, and payer mix, even in areas where there are dental clinics.
Coverage: On the government payer side, traditional Medicare excludes dental coverage, so many people enroll in Medicare Advantage plans for dental coverage. However, only 40% of U.S. counties offer a Medicare Advantage plan with comprehensive dental coverage.[viii] Medicaid and CHIP must provide dental coverage for children (through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)), but adult dental coverage is optional and varies by state. Programs with limited benefits typically cover only emergency or medically necessary services, such as extractions or treatment of acute pain and infection, while 38 states plus Washington, D.C. offer enhanced benefits that, with some variability, extend coverage to preventive, diagnostic, restorative, and, in some cases, prosthodontics (i.e., tooth restoration or replacement with prosthetics such as dentures, veneers, and implants).
New York has a relatively inclusive Medicaid dental benefit: per 18 N.Y.C.R.R. § 506.2, it covers “preventive, prophylactic and other routine dental care, services and supplies, and dental prosthetic and orthodontic appliances required to alleviate a serious health condition including one which affects employability” and services “deemed essential to maintain an adequate level of dental health.”
In 2024, the State expanded Medicaid coverage for crowns and root canals in certain circumstances and reined in the prior approval process for dentures and implants following the settlement of Ciaramella v. McDonald. In 2025, the program began to cover silver diamine fluoride, which is a topical treatment used to treat cavities, for all ages.[ix]
Still, a persistent challenge to dental access is the limited number of dental providers who participate in Medicaid. Even when benefits appear generous on paper, only a minority of dental providers participate in the Medicaid program. Furthermore, not all Medicaid-participating providers actually see Medicaid enrollees in their practices. In fact, no state has Medicaid-enrolled adult utilization (i.e., ≥1 past-year dental visit) over 33%.[x]
Medicaid reimbursement rates lag dental charges (costs) by 60% - 75%, which presents a disincentive for providers to see patients for whom the costs of care will not nearly be fully covered, and Medicaid lags commercial rates by 30% to 50% (see Relevant Statistics table). While studies do not compare Medicaid rates directly to commercial rates,[xi] in other types of physician services, Medicare rates typically lag commercial rates by 30%,[xii] and Medicaid lags Medicare by approximately 25%, on average.[xiii]
On the private payer (i.e., commercial) side, dental insurance, which has relatively low premiums, generally covers the recommended biannual cleanings and examinations, but otherwise does not behave like traditional “insurance.” In the medical insurance model, for example, an individual is typically responsible for costs incurred before reaching a deductible, after which the plan kicks in. The enrollee still has protection from out-of-pocket maximums for both in-network and out-of-network costs, so their liability is almost always capped. Dental insurance begins to cover services immediately, but once an individual reaches an annual maximum, typically $1,000-$2,000, it provides no financial benefit.[xiv] For frame of reference, a single crown restoration can easily exceed $1,500.
Health Impacts: The more obvious functions of oral hygiene and regular dental care are to prevent and treat decay and disease, and address sources of discomfort and pain. However, a range of downstream impacts of delayed dental care significantly impacts health and quality of life. Untreated dental disease can result in the loss of affected teeth, which affects a person’s ability to maintain proper nutrition and can complicate existing health conditions or make a person more vulnerable to new ones. Without dental appointments, patients also miss an opportunity for oral cancer screening, a routine part of a visit, which can lead to late diagnoses.
Research suggests the prevalence of high dental fear and anxiety (DFA) is approximately 12% for adults.[xv] Origins of DFA are complex[xvi] but often include negative, even traumatic experiences with dentistry in childhood and adolescence, having felt shamed or embarrassed by dental professionals for their oral hygiene, or having more generalized fear around medical environments and the sensory stimuli of the dentist’s office, as Part II will explore. Those with visibly damaged or missing teeth experience stigma in social interactions, including hiring environments, and report difficulty securing employment in customer-or client-facing roles. Students and employees with tooth and facial pain may be absent more often and less productive.
Cycles of unmet oral health needs and fear of seeking treatment often result in more acute needs that require more expensive, painful, and consequential interventions. In the most severe circumstances, individuals can develop potentially fatal infections resulting from the spread of a local oral infection to nearby sinuses, the brain, or bloodstream (i.e., sepsis).
Costs: As is the case with preventive general medicine, those without regular access may turn to acute care settings, such as the emergency department, which is not well equipped to address underlying causes. For example, one could have a dental abscess incised and drained in the emergency room, and could be given a prescription to manage the infection and associated pain, but could not have a root canal or tooth extraction in that setting.[xvii]
Despite the limited treatment capability in the emergency department, an annual average of 423,000 emergency department visits have a primary diagnosis of periapical abscess (i.e., infection at the root of the tooth) in recent years, with an average charge of $2,585.[xviii] Overall, people presenting to emergency departments with dental complaints are estimated to account for $2B in annual healthcare expenditure. National dental expenditures reached $174 billion in 2023, comprising 3.6% of total health expenditures.[xix]
The June 8, 2023, meeting of the Public Health and Health Planning Council (PHHPC) Health Planning Committee highlighted relevant New York findings: about 60% of ED visits for non-traumatic dental conditions are covered by Medicaid, with most of the remainder uninsured. The summary cited an examination of Medicaid data by the Dental Quality Alliance, which found that only 30% of patients who visited the ED for a dental complaint obtained follow-up dental care within 30 days, while 60% returned to the ED.
Relevant Statistics
Preventive Care: In 1999, the CDC named community water fluoridation (CWF) (1945) one of the “Ten Great Public Health Achievements” of the 20th century, citing its role in preventing tooth decay and tooth loss and emphasizing its equitable availability.[xxxiii]
Yet the current federal administration has undermined the scientific evidence supporting community water fluoridation (among other public health interventions that have consensus support), with Secretary of Health and Human Services Robert F. Kennedy Jr. directing the CDC to stop recommending CWF and encouraging states to prohibit it. These developments illustrate how oral health prevention efforts, despite a strong evidence base and widespread benefits, remain politically vulnerable and insufficiently integrated into health policy.
Part II: Dental Care and Intellectual and Developmental Disabilities
This paper does not advance a single prescriptive reform but instead describes the current delivery landscape and structural barriers to access, and highlights opportunities to improve oral health outcomes for individuals with IDD in New York.
Background on intellectual and developmental disabilities
Intellectual and developmental disabilities are the umbrella term for conditions that begin in childhood and affect development, physically, intellectually, emotionally, or a combination thereof. “Intellectual disabilities” are one category within the wider taxonomy of “developmental disabilities.”[xxxiv] Examples of IDD include autism spectrum disorders, cerebral palsy, and Down syndrome. Developmental disabilities can affect mobility, learning, language and communication, and other aspects of development and independence.[xxxv]
As of 2020, the latest national data available, there were approximately 6.1 million children with IDD, 20% of whom were known to state IDD agencies, and 2.3 million adults with IDD, 44% of whom were known to state IDD agencies, in the United States.[xxxvi] The pie chart on the left, below, shows where the 1.4 million Americans with IDD who receive one or more long-term support or service (LTSS) live. This is not perfectly reflective of patterns in the IDD population as a whole, but represents reliable information about individuals who receive state services related to their conditions.
In New York, the Office for People With Developmental Disabilities (OPWDD) serves as the state IDD agency. As of 2024, approximately 135,000 individuals with IDD received OPWDD Medicaid-funded services, a figure that has grown by roughly 15,000 since 2019.[xxxvii] More than one-third of those served (35%) are under age 21. Intellectual disability across all severity levels is the primary diagnosis for approximately half of those served, followed by autism spectrum disorder (29%), and conditions including cerebral palsy, epilepsy, and other neurological and developmental conditions, making up the remainder. Services are coordinated through a network of over 400 nonprofit providers across the state, with both state-operated and voluntary programs delivering services and supports in home, community, and residential settings.
The pie chart on the right displays similar residential data as the national chart, but for OPWDD clients in New York.
The population with IDD has a lower age-at-death (i.e., a measure similar to life expectancy) than the general population. For those with intellectual disabilities overall, their age-at-death is approximately 9 years earlier; 16 years earlier for those with Down syndrome, 19-21 years earlier for those with cerebral palsy, and 26-31 years earlier for those with other rare developmental disabilities.[xxxviii] Each of these disparities is wider than those for other commonly compared populations (e.g., by race, sex, geography).
There is considerable evidence in scientific literature and from advocates that people with a variety of disabilities face exceptional barriers accessing health care, including in the most literal sense of physically accessing settings of care if they have mobility challenges, and especially if they use a wheelchair. These barriers are reinforced by a clinical culture influenced by pressure to meet productivity targets, which emphasize volume and incentivize limited visit time.[xxxix]
IDD and Dental Care
Numerous publications, including the 2024 edition of the State of Oral Health Equity in America (SOHEA) survey, have found that individuals with disabilities have relatively worse access to dental care and more acute oral health needs than those without disabilities. In that survey, 30% of adults with a disability reported that their dental practice does not provide accommodations. Adults with a disability have significantly higher odds of having visited a hospital emergency department for dental care than adults without a disability.
Unfortunately, data about oral health access challenges specifically among the IDD population are limited, in part because of states’ varying definitions of the scope of IDD, and in part because dental billing strictly reflects services rendered rather than co-diagnoses a patient may have.[xl]
The 2024 Oral Health Needs Assessment for New York State evaluated regions’ oral health needs across 15 indicators, such as the population-to-dentist ratio, the percentage of residents with optimally fluoridated water, and the percentage of children with at least one dental visit, as well as a range of demographic characteristics. The percent of individuals with a disability was the highest-ranked indicator of high oral health needs:
Practical Challenges Accessing Care
For many individuals with IDD, access to dental care is mediated through their caregivers—often family members— whose role extends well beyond appointment accompaniment. Caregivers are often responsible for identifying providers able to serve individuals with IDD, navigating insurance and State services eligibility and enrollment, coordinating transportation, and managing pre-visit preparation and post-procedure recovery. They may serve as intermediaries, communicating sensory sensitivities, behavioral support needs, and medical history to staff.
Obtaining routine dental care can involve an extended search process. Families may call multiple practices before locating one that both accepts Medicaid and is comfortable serving individuals with IDD. They may encounter months-long waitlists or have to travel across county lines to reach a suitable provider. Caregiver networks, including groups on social media, are a popular resource for (informal) referrals. Local chapters of The Arc, OPWDD representatives, and care coordinators also offer guidance. Federally qualified health centers are a common initial entry point for routine dental care for Medicaid-enrolled individuals, even if they do not offer special needs dentistry specifically. Further challenges emerge for those requiring deep sedation or general anesthesia.
A recent article from the University of Rochester Medical Center highlighted the experience of Kathy Caruso and her 30-year-old son, Nicholas, who has IDD. About her son’s loss of five adult teeth, she said:
“’If he had been able to get regular x-rays, cleanings and fillings under sedation in an operating room setting, it wouldn’t have happened,’ she said. ‘But because of his special needs, we have struggled his whole life to find good dental care for him’….’I brush my son's teeth daily,’ Kathy said. ‘And even though I have been one of the few able to find a local and compassionate dentist, she does not have access to an operating room or an anesthesiologist. Even a checkup with x-rays is not possible due to Nick's resistance and anxiety, so a thorough exam and procedure is not possible.’”[xli]
Waitlists for special needs dentistry can be years long: Nicholas was once placed on a two-year waitlist for follow-up care, which grew to five years during the COVID-19 pandemic. For caregivers who are already managing medical appointments and daily caregiving responsibilities, dental care is more often another complex logistical undertaking rather than a straightforward preventive service. In these circumstances, regular dental visits may seem secondary to more urgent medical or behavioral needs, leading to delayed or missed care, especially given the persistence of waitlists statewide.
When appointments do take place, the technical aspects of dentistry do not necessarily differ, but the surrounding environment and pace of care may require adjustment and accommodation. Patients may benefit from additional time to acclimate to the setting, simplified explanations, sensory support tools, or a combination thereof, depending on their conditions. These needs are not inherently extraordinary; however, in a delivery system structured around short, high-volume visits, providers are not accustomed to adding steps to their workflow or slowing their pace for a patient’s comfort. Some caregivers report encountering discomfort or hesitation from providers who lack experience with caring for patients with IDD, reinforcing the importance of referrals from trusted caregiver peers.
NB: Although this Issue Brief will focus on IDD, individuals with traumatic brain injury (TBI) and those residing in institutional settings such as nursing homes have many overlapping challenges and stand to benefit from some of the solutions described below, particularly mobile dentistry programs.[xlii] Individuals with TBI are a small group with particular needs that is carved out of managed care; their concerns are often eclipsed by issues affecting larger groups when it comes to policy-making.
Financial Challenges
Only 67% of adults with a disability report having dental insurance, compared to 77% of adults without a disability.[xliii] Medicaid is the primary payer for New York’s Office for People with Developmental Disabilities, which serves approximately 135,000 people. The process for qualifying for OPWDD services can be complicated, and there may be individuals who would be considered as having IDD who are not OPWDD clients.
Some individuals with IDD are dually enrolled in Medicaid and Medicare on the basis of disability, and some children are insured by a parent’s employer-sponsored coverage. There are individuals with IDD who may have challenges relevant to dental care, but do not have other needs that would make them appropriate for Home and Community Based Services (HCBS) or other higher-intensity services that could be a motivating factor to pursue the complex process of acquiring approval for OPWDD services.
For example, a person with autism who has intense sensory sensitivities would benefit from a better prepared dental care team and more accommodating clinical setting, but may not need assistance performing activities of daily living or maintaining employment. This Issue Brief will focus mostly on Medicaid in the context of payment for dental services, and will generally reflect individuals eligible for OPWDD services, but the broader issues are not limited to any one payer type or disability services status.
Medical Challenges
Individuals with IDD may face elevated oral health risks due to a combination of anatomical, behavioral, and medication-related factors. Common challenges include impaired chewing and swallowing, drooling, and atypical dental development that can result in alignment problems. Behaviors such as grinding (bruxism), jaw clenching, and chronic mouth breathing can accelerate enamel wear and contribute to gum inflammation and tooth sensitivity. For individuals with epilepsy, seizures can increase the risk of oral injury, and long-term antiepileptic therapy can have side effects affecting the gums (e.g., gingival hyperplasia), which raise the risk of dental caries and oral infection.[xliv]
New York Medicaid’s dental policy and procedures reflect a recognition of this vulnerability: members with OPWDD managed care exemptions (and TBI managed care exemptions) can qualify for an additional prophylaxis service within a twelve-month period, beyond the standard preventive visit limits. Similarly, Medicaid permits adults age 21 and older with OPWDD- and TBI-related managed care exemption codes to receive fluoride varnish (described later) as frequently as once every three months; fluoride varnish is not covered for adults at any interval in the default Medicaid dental benefit.
Even if individuals with IDD receive preventive dental care, they are less likely to receive restorative care for active conditions, so they are not only vulnerable to dental disease, but to the secondary effects of tooth loss, mainly malnutrition.[xlv]
Clinical Challenges
Individuals with IDD may have difficulty maintaining oral hygiene at home, especially if they are sensitive to the sensory aspects of these tasks or have limited mobility for the motions necessary to regularly and effectively brush and floss their teeth.[xlvi] They may, therefore, warrant more than biannual professional cleanings. However, individuals with IDD may have co-occurring mental health conditions, have difficulty comprehending information communicated during an appointment, have difficulty communicating directly with dental office staff, or have other circumstances that increase dental fear and anxiety. Dental care is highly interventional and potentially overstimulating, compared to, for example, the average annual physical; researchers often point out the high burden of patient communication and cooperation with clinicians in this environment.[xlvii]
New York Medicaid implicitly recognizes this dynamic through its coverage of an “observation visit” code (D9430), which reimburses limited encounters when the provider cannot complete dental treatment, but the patient benefits from acclimating to the practice environment and being evaluated. And Medicaid’s clinical criteria for reimbursement of silver diamine fluoride – a topical treatment that halts the progression of decay and does not require drilling – includes cases where treatment is “challenged by behavioral or medical management.”
As is the case among the general population, there are tools available to make dental care more inclusive and more comfortable for patients with dental anxiety or significant discomfort and overstimulation. Conscious sedation or benzodiazepines may be used in these cases, as well as sensory adaptations such as dimmed overhead lights, quiet office policies, or therapeutic weighted blankets.[xlviii] General anesthesia may also be used for dental procedures if the dentist has advanced training and/or appropriate personnel are available.[xlix] Given its risks relative to local anesthesia, general anesthesia is typically reserved for cases involving patients who cannot be adequately managed with lighter sedation, such as those with severe anxiety, significant behavioral or cognitive challenges, or complex medical conditions, as well as lengthy or highly invasive procedures where deeper sedation is clinically necessary.
Further, some dental settings may not be able to accommodate patients with certain physical manifestations of IDD, such as those who use a wheelchair or require assistance transferring to a dental chair.[l] Research has shown that accessible dental furniture, combined with extended appointment times and trained providers, helps improve the experience of care for dental patients with IDD. There are many smaller-scale tools, such as various joint support pillows, mouth rests (which help keep the mouth open with less patient effort), and airway positioners, which practices can purchase from vendors to make dental visits safer and more comfortable for patients. A small number of practices, including New York University College of Dentistry’s Oral Health Center for People with Disabilities, have a “wheelchair tilt,” which allows the provider to deliver care in the patient’s own wheelchair and avoid the discomfort and time associated with transfers.
Barriers to dental care for individuals with IDD are often operational rather than strictly clinical. Even when appropriate services exist, issues with scheduling, intake, waiting-room environments, staff training, and visit pacing (i.e., time between visits) can prevent care from occurring or create interruptions, contributing to avoidable clinical escalation to sedation, general anesthesia, or the need for relief in emergency settings.
For patients who need deep sedation and general anesthesia, access is constrained by the capacity of dental anesthesiologists, limited hospital operating-room availability for dental procedures, and reimbursement structures that often deprioritize dental cases relative to medical surgeries. Hospitals often require board certification for medical staff, which can make it difficult for general dentists to obtain privileges. Meanwhile, although outpatient/ambulatory surgery centers are common and easier to access, they may not be the appropriate setting for complex patients.[li]
For patients who require medical immobilization/protective stabilization (i.e., a technique to restrict patient movement for their safety and the safety of providers), pharmacologic adjunctive therapies, conscious sedation, or general anesthesia, there are additional resource requirements, including access to anesthesiology services, appropriately equipped facilities, longer appointment times, and coordination of transportation for patients and caregivers, which further narrows the pool of providers able to deliver care.
Workforce Challenges
New York faces an overall shortage of dental providers, a constraint that is particularly acute in rural and other underserved areas. The State Comptroller’s report last year, The Doctor is…Out: Shortages of Health Professionals in Rural Areas, found that the ratio of dentists per 10,000 residents in rural counties was less than half of the statewide ratio of 8.3, and that Hamilton County has zero dentists.[lii] Statewide, there are approximately 10,600 general dentists; there are about 800 pediatric dentists, some of whom are also counted as general dentists. This baseline capacity is limited even before accounting for the additional time, training, and resources often required to serve individuals with IDD.[liii]
Until 2019, dental trainees were not required to have any clinical experience treating individuals with disabilities, and many dentists and dental hygienists report that they do not feel adequately prepared to treat patients with sensory sensitivities or behavioral challenges. Interviews with providers and caregivers suggest that reluctance to treat adults with IDD often reflects uncertainty about workflow, staffing, and reimbursement rather than categorical refusal to provide care.[liv] In addition, some practices lack specialized equipment—such as wheelchair-accessible procedure rooms (referred to as operatories in dentistry) or adaptive positioning tools, that are necessary to safely and effectively provide care to this population.
Workforce participation is also shaped by broader structural trends in dental practice. New graduates carrying substantial educational debt may opt for employment through Dental Service Organizations (DSOs), which manage business operations for affiliated practices. These models can offer financial stability and “back-office” support, but stress standardized scheduling and productivity targets. In these environments, longer appointment times and lower Medicaid reimbursement present operational challenges, even when individual clinicians are motivated to provide care to individuals with complex needs, including IDD.
As is widely recognized in oral health research more generally and described in Part I, too few dental practices serve patients with Medicaid coverage, and individuals with IDD are more likely to use Medicaid for oral health services than individuals without IDD.[lv] Large DSOs are also less likely than safety-net providers to participate in Medicaid, especially in markets where commercial coverage predominates. As practice consolidation through DSOs increases, these dynamics may further narrow the pool of providers available to publicly insured individuals with IDD.
Highlighting the Access Cliff
While children with IDD generally receive more consistent dental care than their adult counterparts, advocates have been sounding the alarm about the access “cliff” awaiting individuals as young as 12. Pediatric dentistry’s position as an “age defined specialty” does not fully account for developmental and healthcare-related needs across the lifespan, thus creating additional barriers to access.
Pediatric practices may discharge youth with IDD prematurely if they physically outgrow pediatric equipment or their needs become more complex. Adult dentistry providers may not be equipped to care for them due to their age, leaving no clear receiving system for individuals with IDD once their pediatric care ends.
Experts have identified a number of steps to improve the experience of dental care transition around the Access Cliff. In September 2025, Dr. Chelsea Fosse, Director of the Research and Policy Center at the American Academy of Pediatric Dentistry, presented an Oral Health Workforce Webinar called Transforming Pediatric to Adult Dental Care Transition – Prioritizing People with Disabilities. Her presentation identified a list of concrete actions to improve transitions of care for children and youth with special health care needs (another term commonly used in federal parlance to include youth with IDD) via the American Academy of Pediatric Dentistry’s Transition Advisory Group:
Adopting the Six Core Elements Of Health Care Transition tool from Got Transition®
Pursuing a procedure code for the process of care transition itself, as in medical billing (e.g., ICD-10 code Z71.87: Encounter for pediatric-to-adult transition counseling)
Introducing a quality measure focused on dental care transition (e.g., NQF measure 1340, Children with Special Health Care Needs Who Receive Services Needed for Transition to Adult Health Care)
Revising professional policy and best practices
Pursuing transition-related suggestions advanced in the 2025 MACPAC Report to Congress on Medicaid and CHIP[lvi]
“Require CMS to issue guidance to states on coverage for transition services
Require states to develop and implement a strategy for transition
Require states to collect and report transition data
Require coordination between Medicaid and Title V (maternal and child health agencies)”
Policy Initiatives
Stakeholders across the country have acknowledged and begun to respond to longstanding gaps in dental care access for individuals with IDD. There have also been organized efforts to think at the State policy level on this topic, including a Special Dentistry Task Force organized through OPWDD.
Training
Dental professionals seeking additional training, and families and caregivers of individuals with IDD seeking guidance on oral hygiene, rightly point out that there is no single, obvious repository of publicly available relevant training materials. However, it does not go without saying that investment should go toward researching and creating new materials. Instead, it would be worth taking inventory of the many existing training resources, both within New York’s many institutions and from other states, as some of the topics, such as clinical techniques, are not specific to geography or payer type.
From there, it would be useful to designate a single, comprehensive website focused on training resources for special care dentistry. Ideally, the authors of existing resources, described in the following two sub-sections, would be amenable to sharing those resources with this central library to improve their reach.
It is not immediately clear on which institution’s website an IDD version should be hosted, but that question should not preclude an effort to consolidate dozens of valuable, existing training materials so they can reach broader audiences. The Oral Health Otter, which is focused on the oral health of babies and young children and hosted on the website of the Council for Children and Families, models this idea, as seen in the screenshot below.
Separate sections of the website would be directed toward different audiences: individuals with IDD, families and caregivers, and dental professionals— but all material would be public. Further stratification could be appropriate, such as adding a sub-section for billing professionals, adding filters by patient age to relevant technical training topics, and announcing forthcoming continuing education seminars for licensed dental professionals.
Dental Professional Training
Since 2019, the Commission on Dental Accreditation (CODA) has required U.S. dental schools to include training on treating patients with IDD, addressing a longstanding gap in dental education. Per CODA’s Accreditation Standards for Dental Education Programs:
“2-25 Graduates must be competent in assessing and managing the treatment of patients with special needs. Intent: An appropriate patient pool should be available to provide experiences that may include patients whose medical, physical, psychological, or social situations make it necessary to consider a wide range of assessment and care options. As defined by the school, these individuals may include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly. Clinical instruction and experience with the patients with special needs should include instruction in proper communication techniques including the use of respectful nomenclature, assessing the treatment needs compatible with the special need, and providing services or referral as appropriate.”[lvii]
However, most currently practicing dentists completed their training before this requirement took effect, so disparities in provider readiness are likely to persist, absent continuing education opportunities that extend similar training to the existing dental workforce.
Tuoro College of Dental Medicine (TCDM) hosts on its YouTube channel a playlist of ten videos of Special Needs Dentistry Continuing Education webinars the College hosted in partnership with OPWDD, ranging from ethical issues, to caregivers’ lived experiences, to technical discussion of sedation alternatives. New York University’s dental school hosted an eight-session webinar series on managing the oral health needs of patients with disabilities during the early months of the COVID-19 pandemic. Material from other states, such as a module from Pennsylvania’s Oral Health Coalition, could also be adapted to provide CE credit in New York State, which requires approval from the New York State Department of Education.
New York University College of Dentistry’s Oral Health Center for People with Disabilities has developed workforce initiatives aimed at strengthening provider readiness. Its “Unit Zero” webinar series offers free continuing education courses for dental educators on caring for individuals with disabilities, featuring national experts in special care dentistry. In addition, its three-day Delta Dental Foundation Centers for Inclusive Dentistry Immersion Program brings in interdisciplinary teams from FQHCs and community clinics for intensive training in clinical best practices, workflow adaptation, and sensory accommodations. The program has trained more than 400 dental professionals, including teams from five dental schools, and was highlighted as a best practice in a 2023 National Council on Disability report.[lviii]
Although continuing education is a critical setting for professional training, schools are the most natural place to educate future providers about caring for this population. NICHE-Dental is a free IDD curriculum toolkit educators can use to inform professional students about caring for those with IDD. NICHE, which is a program of the American Academy of Developmental Medicine and Dentistry, also offers a general medical version of the toolkit.
Caregiver Education
Smiles United, also based at Tuoro College of Dental Medicine,[lix] is led by two TCDM faculty members with advanced training in special care dentistry. The program team developed a series of educational, pre-recorded videos that explain and demonstrate helpful techniques for maintaining the oral health of residents in group homes. The program has also distributed oral hygiene kits with supplies tailored to the specific needs of the residences and their clients.
The Delta Dental Foundation, an affiliate of the largest commercial dental insurer in the country, hosts “Access for All Smiles,” comprising a 55-page, organized PDF guide, a series of brief video modules, and one- or two-hour video trainings for caregivers.
In New York, caregivers of OPWDD clients can also get training on brushing and flossing from care managers.
Specialty Recognition
Given the long-standing awareness of the needs of individuals with IDD, and the organic organization that has grown around this issue, it is notable that this professional focus area is not yet a recognized specialty.
In the UK, the General Dental Council formally recognized “Special Care Dentistry” as the 13th dental specialty in 2008, focused on patients “who are unable to accept/receive routine dental care because of a physical, sensory, intellectual, mental, medical, emotional, or social impairment or disability or a combination of these factors.”[lx] Australia recognized its “Special Needs Dentistry” specialty in 2003, and dental students commit to that specialty from the beginning of their training.[lxi] Dentists stateside have advocated for recognition of “Special Care Dentistry” or “Special Needs Dentistry” by the National Commission on Recognition of Dental Specialties and Certifying Boards.[lxii]
There is a national Specialty Care Dentistry Association headquartered in Texas, which combines disability- and geriatric-focused dentistry trade organizations dating back to the 1950s and 1960s. The Association offers affordable continuing education modules, and in 2002, the Association established its own credentialing board, the American Board of Special Care Dentistry, specifically to offer “Diplomate” distinction to practitioners with this expertise.
New York State Academic Dental Centers, which represents New York’s six dental schools, offers a Fellowship to Address Oral Health Disparities, which is focused on the care of patients with IDD. The fellowship, which is fully funded by the State, expects a commitment of one year post-completion to serving this population within New York State and is available to dentists who are recently licensed or those established in practice who want to develop this expertise.[lxiii] Although the program did not receive enough applications last year to fill its slots, it had more applicants than slots in the most recent cycle following increased marketing and recruitment efforts. The New York State Developmental Disabilities Council has affirmed the value of these programs and called for their expansion.[lxiv]
At present, there are known hubs of research and clinical expertise in caring for the IDD population, some of which offer specialized training for clinicians. Locally, Stony Brook School of Dental Medicine offers a one-year Special Needs Dental Care Fellowship Program. The University of Pennsylvania offers a certificate program for “Dental Care for Persons with Disabilities.” The Harold Diner Special Care Dentistry Center at the Children’s Hospital at Montefiore Einstein offers outpatient sedation and has more than 4,000 visits annually. The Eastman Institute for Oral Health at the University of Rochester operates several specialty clinics for patients with IDD and complex conditions, serves nearly 2,000 individuals with IDD annually from more than 40 New York counties, and offers specialized training to residents on IDD. The University at Buffalo School of Dental Medicine also contributes to this landscape, with faculty leadership in the American Academy of Developmental Medicine and Dentistry.
OPWDD maintains a listing of special needs dentists on its website, which can be filtered by county and has a filter for facilities with general anesthesia capacity.
Training Recommendations
NYS oral health and IDD stakeholders (e.g., including OPWDD, DOH, NYS Oral Health Coalition, patient and caregiver groups) should determine 1) a centralized location to host and 2) which entities can help collate available, trusted training resources for all audiences in a user-friendly format, with translation options and full accessibility functions.
Potential topics for patients and caregivers include:
Information about eligibility for and support with pursuing relevant managed care exemption codes
Advocacy around caregiver home application of fluoride varnish
Availability of dental care in alternative settings
Potential topics for dental providers, including the dental professionals defined in Part I, as well as office managers and billing staff, include:
Eligibility requirements for OPWDD designations that correspond to enhanced rates
Clinical accommodations and workflow adaptations, including patient intake and communication methods, for more successful, efficient visits
Proper billing procedure for enhanced reimbursement mechanisms, including RE 95 and RE 81 designations and dental case management
Utilize available space to cross-market relevant public resources, such as by linking to the OPWDD eligibility process on the DOH Medicaid Dental website, to avoid the ongoing challenge of siloed information.
Promote dental professional students’ early awareness of and exposure to work opportunities caring for the IDD population, including by increasing formal education opportunities, investing in sustaining and growing specialized fellowships, and recognizing special needs dentistry as an ADA dental specialty.
Care Delivery and Preparedness
Experts on special care dentistry, including experienced caregivers, emphasize the benefits of preparing not only the dental patient, but also the care team ahead of the visit to set expectations and communicate needs. There are many factors that the dental care team and the dental practice as a physical setting can help control, such as by pursuing additional training in treating patients with IDD, incorporating assistive devices, furniture, and other tools, streamlining workflows to limit time patients must spend waiting between seeing a hygienist and a dentist, or transitioning from one step of an appointment to another, and intentionally communicating what they are doing and why at regular intervals throughout the appointment.
There are also a number of techniques caregivers can use to minimize complications during a visit, such as sharing details with the care team in advance about the dental patient’s particular needs, as described in the next sub-section. They can also schedule appointments early to avoid waiting for the dentist to finish seeing other patients, as delays can increase anxiety, and they can bring sensory tools such as headphones, sunglasses, weighted blankets, or fidget toys to provide distraction and relief from discomfort during the appointment.[lxv] A 2022 National Council on Disability report pointed out that many common sensory adaptations, such as quieter environments, dimmed lighting, and weighted blankets, are part of a patient-centered approach and may reasonably be viewed as disability accommodations under the Americans with Disabilities Act.[lxvi]
Dental Care Passport
Several states have piloted non-coverage interventions to address communication and care-coordination barriers in dental settings. One example is “My Dental Care Passport,” developed in Kansas through the Pathways to Oral Health initiative, a nationally well-regarded, multi-stakeholder effort involving Oral Health Kansas, disability advocates, dental providers, Medicaid stakeholders, and insurers. The Passport functions as a standardized, portable supplement to traditional medical and dental histories, capturing information often omitted from routine intake processes, such as sensory sensitivities, behavioral support needs, prior dental experiences, and flags for any needed protective stabilization, pharmacologic adjunctive therapy, or sedation.
The tool is intended to support pre-visit workflow planning and team-based care by allowing dental practices to anticipate accommodations, allocate appropriate time and staffing, and assess whether care can be safely delivered in an outpatient setting or requires referral to a facility with anesthesia capability. Kansas has implemented the Passport with provider- and patient-facing guidance and targeted outreach, particularly within Medicaid populations. While the Passport does not address workforce shortages or reimbursement constraints, it illustrates how structured care-planning tools can mitigate access barriers related to provider confidence, communication, and visit complexity for individuals with IDD.[lxvii] Representatives from Kansas’s program recently presented on this topic at a meeting of the NYS Oral Health Coalition and encouraged New York to draw on its efforts to date.
OPWDD already has forms on its website for recipients or their caregivers to detail their health and dental history, as well as social and behavioral information ahead of a dental visit, which were developed by the Task Force on Special Dentistry, but the form completion and submission is not at all automated. Ideally, a NYS Dental Care Passport could utilize the State Health Information Network of New York (SHIN-NY) infrastructure to transmit this information, similar to how data from social care networks, per the State’s current 1115 waiver, interact with the SHIN-NY.
OPWDD recently solicited interest for an electronic dental record solution, which, when selected and implemented, could be an important tool for continuity of care and streamlining of patient information. Ideally, electronic dental records will become more common and better integrated with existing electronic medical record solutions.
Regional Disability Health Clinic Program
There are dental practitioners in New York State who would like to see more patients with IDD but need support in adapting their spaces to do so adeptly. The State recently announced a $25 million capital project grant initiative to improve the accessibility of various healthcare settings, including dental, noting:[lxviii]
“Application Criteria for Suitable Projects: Capital projects that improve both access to and the quality of physical health care services (e.g., medical, dental, nursing, physical therapy, occupational therapy, speech and language pathology) specifically for people with developmental disabilities….OPWDD will prioritize projects related to opening new dental services or expanding/enhancing existing dental clinics, improving physical space to better accommodate wheelchairs, improving physical space to create sensory-friendly spaces, and improving access to specialty physical health services in ‘health care deserts.’”
This Regional Disability Health Clinic Program’s RFP application window closed on November 12, 2025, and awards are expected in February 2026. Article 16 and Article 28 licensed clinics were eligible to apply.
The program is structured as a capital-focused initiative, with funding limited to physical plant, equipment, and certain upfront health technology investments, and with explicit exclusions for staffing, training, and ongoing operational costs. These parameters clearly define the types of projects eligible for support, though this list raises important questions about whether the scope of allowable expenses adequately aligns with the types of needs providers report in serving people with developmental disabilities.
For example, while considerable attention is (appropriately) focused on the supply of dentists, the delivery of dental care for individuals with IDD also depends on the availability of registered dental assistants, dental hygienists, and administrative staff who are trained to support longer visits, modified workflows, and coordination with caregivers. Staffing shortages, turnover, and limited training can constrain access even in areas with physical capacity and willing providers. Such operational challenges make capital-focused initiatives, however necessary, insufficient on their own.
Integration and Co-location
Across the country, providers are piloting models to innovate dental care delivery for this population. Mirroring approaches used to integrate and co-locate behavioral and maternal health care into primary care settings, basic dental services can similarly be embedded into primary care through interdisciplinary, team-based workflows, shared clinical infrastructure, and coordinated referral. This model is often called “medical dental integration,” or MDI.
In MDI models, primary care may serve as the access point for screening, triage, and care navigation, while dental providers deliver services within the same clinical setting, which limits the risk of a failed external referral due to transportation challenges, provider availability, or other reasons. Integration also promotes efficiency through shared documentation and more consistent follow-up, including coordination around sedation needs, medical complexity, and behavioral supports.
In another natural parallel to behavioral health integration into primary care, the concept of “reverse integration” applies here, too. As described in the Professional Roles section, dentists are clinically prepared, and it is within their scope of practice to screen for various physical health ailments and chronic diseases, such as diabetes and hypertension, although this practice varies, largely due to difficulty adding components to an often-brief dental visit.[lxix] The principle of “meeting people where they are” is especially prudent in serving the IDD population. Taking advantage of screening and referral services from any setting where a patient is getting care already can help reduce the risk of a patient falling through the cracks.
A pilot program at Mile Square Health Center, an FQHC in Chicago, recently evaluated an interdisciplinary oral health model for adults with intellectual and developmental disabilities, enrolling 50 patients, most of whom had experienced prolonged gaps in dental care and difficulty finding accessible providers.[lxx] FQHCs are one of the ideal settings for MDI in general and in the context of individuals with IDD, due to the proximity of various specialists, patients’ likelihood of having an existing relationship with the facility and awareness of their processes, and familiarity with serving Medicaid members and billing for their care.
The pilot leveraged the FQHC’s co-located medical, dental, and behavioral health services, using internal referrals and care coordination and shared clinical space to connect patients to dental care more reliably. Following targeted workflow changes, such as extended, 75-minute visits, accessibility adaptations, trained providers, and integrated, internal referrals, nearly all patients reported that providers understood their disability-related needs, felt sufficient time was allotted for care, and expressed high overall satisfaction. This case study suggests that relatively modest changes to scheduling, training, and care integration within existing safety-net settings can meaningfully improve access and patient experience for adults with IDD.
Notably, there has been some incongruence with scope of practice for dental professionals, especially as it relates to providing integrated and non-dental care. For example, although the FY27 New York State Executive Budget is (laudably) advancing legislation to allow medical assistants to administer vaccines under supervision, they are not allowed to apply topical fluoride varnish. Although dentists regularly administer injection medication, particularly local anesthetic, they are not allowed to administer vaccines. During the COVID-19 public health emergency, the New York State Education Department (SED) relaxed regulations to permit dentists to administer the COVID-19 vaccine, and recent legislation has proposed codifying this scope expansion, though only during other public health emergencies (see: Assembly Bill A3894). S4548, which would permit dentists to administer HPV vaccination, recently passed the Senate and is in an Assembly committee.
While these individual efforts are positive, authorizing piecemeal exceptions to the status quo can create a confusing patchwork of approved professional activities. Instead, the State’s more comprehensive approach to training and certifying pharmacists to administer a range of vaccines is a useful model for expanding dentists’ role in vaccination.
Care Delivery Recommendations
OPWDD should communicate with leaders in Kansas to utilize their materials to incorporate features of the dental care passport into OPWDD’s existing pre-visit forms. In the long term, the State should explore how to utilize SHIN-NY infrastructure and the in-development OPWDD electronic dental record to automate data sharing between providers.
Individuals with IDD, their families, and caregivers should be informed of the available, free tools for communicating their needs with providers in advance, and dental providers should also understand how to incorporate them into visit planning.
Support FQHC and primary care providers in offering basic oral health services to improve “no wrong door” access for individuals with IDD.
Effectuate commonsense alignment of scope of practice laws, including to more accurately recognize the medical training of dentists, reflect the safety of administration of topical fluoride, and address other such incongruences.
Insurance Coverage and Billing
National dental organizations have increasingly identified the transition from pediatric to adult dental care for individuals with IDD (described earlier as the “access cliff”) as a discrete area of weakness in dental delivery, citing the lack of dedicated payment mechanisms, quality measures, and clear accountability for ensuring continuity of care into adulthood.
In parallel, efforts to improve care coordination and continuity are emerging through clinical coding and care tools, including the 2022 addition of an ICD-10 code for pediatric-to-adult transition counseling (Z71.87) and ongoing proposals to modify the CDT code set to better account for care transitions and accommodations for individuals with disabilities.[lxxi]
New York is one of at least 12 states whose Medicaid program covers certain dental services for adults with intellectual and developmental disabilities that are not covered for other adult beneficiaries.[lxxii]
Many practices are unaware of their ability to bill comprehensively to account for the codes and encounter types described below, and even those that are familiar may not do so correctly or consistently. There is also a broader opportunity to educate providers about the population health impact and considerable indirect savings they could help achieve by better serving the IDD population, regardless of payer. To the latter point, recent research suggests that states are likely to realize significant Medicaid savings from closing access gaps for the IDD population.[lxxiii]
Enhanced Reimbursement Rates
In New York, dental practices can bill Medicaid for an enhanced reimbursement rate of 20% above fee schedule for dental services provided to the population with IDD using “Restriction Exception” or “RE” code 95 (OPWDD/Managed Care Exemption) or RE code 81 (TBI eligible).[lxxiv] Individuals with this designation also qualify for certain covered services at older ages. For the provider to be able to obtain the enhanced reimbursement rate, the patient must be found eligible by OPWDD – something that families and caregivers may not be aware of if the individual has not received OPWDD services in the past.
Some providers report uncertainty about whether additional administrative steps are required to access enhanced rates, potentially dampening participation even where enhanced reimbursement is theoretically available. These dynamics suggest that this preferential coverage design is incomplete without corresponding provider-side education, engagement, and participation.
N.B.: I was unable to obtain responses by our publication date to multiple data requests I submitted to the Department of Health. If I receive access to this data in the future, I would explore trends in utilization of the codes and, ideally, observe an increase in their claims following provider billing outreach and education. Appendix B includes the parameters of my data request.
Moving Oral Health Workforce Reform into Practice, the January 2026 report from the Schuyler Center for Analysis and Advocacy, recommended a variation on this idea: “New York should track and report RE81 and RE95 claim submission and approval rates during an initial 12-month implementation period. These data should be used to identify plan-level or regional barriers, refine guidance, and address persistent denials.”
Dental Case Management Billing Code
Individuals who are actively served by OPWDD are, since 2021, additionally eligible for “dental case management,” a billable service that supports the special treatment considerations for this population. New York is one of only four states with such a benefit. Code D9997:
“Does not require a report. Special treatment considerations for patients/individuals with physical, medical, developmental, or cognitive conditions resulting in substantial functional limitations or incapacitation, which require that modifications be made to delivery of treatment to provide customized comprehensive oral health care services. For purposes of the NYS Medicaid program, billing of this code is limited to individuals who receive ongoing services from community programs operated or certified by the New York State Office for People with Developmental Disabilities (OPWDD) with a Restriction Exception code of RE 81 (“TBI Eligible”) or RE 95 (“OPWDD/Managed Care Exemption”). This is a per visit incentive to compensate for the greater knowledge, skill, sophisticated equipment, extra time, and personnel required to treat this population; This fee will be paid in addition to the normal fees for specific dental procedures. A “Medical Immobilization/Protective Stabilization (MIPS)” form (Article 16 institutions only) also qualifies for use of this procedure code. More information about MIPS found online at NYS Office for People With Developmental Disabilities at NYS MIPS. • Not billable in conjunction with D9430 or procedures performed under deep sedation/general anesthesia. • Not billable as a “stand-alone” procedure; another clinical service must be provided on the same date.”
MACPAC identifies dental case management as a key mechanism for addressing access barriers for adults with IDD, particularly for appointment scheduling, transportation coordination, caregiver engagement, and pre-visit planning—functions that are rarely reimbursed under standard fee-for-service dentistry.[lxxv]
Of note, the case management code is not billable as a stand-alone code. It cannot be billed in conjunction with observation visits (D9430) or dental services performed under deep sedation or general anesthesia.
Separating Practice from Billing
As medicine has seen the rise of management services organizations, dentistry has seen considerable growth in dental service organizations. Without endorsing that particular model, it is worth recognizing that this trend signifies demand for outsourcing the business side of clinical practice.
Private practice dentistry is a well-compensated industry, and many dentists do not work a traditional, full-time schedule. Anecdotally, from speaking with dentists in New York State who have served individuals with IDD in IDD-focused settings, it would be mutually beneficial for dentists with flexible and part-time schedules to spend even one shift per month specifically serving this population in other settings.
Building on the proposal to formally recognize special needs dentistry as an ADA specialty, practical experience from providing focused care on a part-time, intermittent basis would allow clinicians to gain experience modifying their workflow and incorporating assistive devices, for example, while tangibly improving the availability of dental care at these facilities. Dental professionals who do not typically serve Medicaid members or a high volume of Medicaid members would have the benefit of access to billing professionals with that experience.
Coverage and Billing Recommendations
DOH and OPWDD should collaboratively offer an educational webinar and publish an FAQ covering, on the consumer side – efforts required to be deemed eligible for the OPWDD managed care exemption codes, and – on the provider side, billing nuances and enhanced reimbursement rates for services provided to individuals with IDD, the dental case management code (D9997), as well as coverage of silver diamine fluoride application.
DOH should publish data to allow analysis of utilization of RE95- and RE81-specific billing codes in Medicaid dental claims, as well as data for dental claims at large through the All Payer Claims Database.
IDD providers should collaborate with dentists on flexible arrangements, so dentists who can occasionally practice in IDD-focused settings but are not familiar with Medicaid billing can provide their clinical services without the associated administrative responsibilities.
IDD-nonspecific Interventions
Finally, there are a number of efforts that are not exclusive to the population with IDD but, when implemented or scaled, would provide immediate benefit to the population.
Expansion of Individuals Permitted to Apply Fluoride Varnish
Topical fluoride varnish is a product applied to the teeth in just a few minutes to harden their surface and prevent cavities. Despite recent federal efforts to undermine the evidence of fluoride in preventing tooth decay and secondary tooth loss, topical fluoride application has long been a reliable tool for pediatric dentistry providers, especially in areas without community water fluoridation, many but not all of which are rural.
The treatment can be applied in dental settings as well as in pediatric primary care practices; in New York, dentists, dental hygienists, physicians, nurse practitioners, registered nurses, and physician assistants can apply the treatment. As of November 2024, New York State also allows registered dental assistants and licensed practical nurses (LPNs) to apply the varnish.
As with any public health issue, a penny of prevention is worth a pound of cure. The 2026 New York State Medicaid Dental Fee Schedule reimburses $30.30 for an application of fluoride varnish every three months (from first tooth “eruption” to age 20), or $14.14 for topical fluoride gel or foam (ages 6-20) application every six months. Research has shown that even biannual application (i.e., only half of the potentially Medicaid-covered sessions) reduces dental caries by 43% compared to placebo.[lxxvi] Another study of the cost-effectiveness of fluoride varnish, which was limited to just one application, by PCPs, and in children under 3 in Virginia Medicaid, still modelled potential savings of $2 million annually from averting later costs of mitigating caries through fillings and other more costly and labor-intensive interventions.6[lxxvii]
In New York, individuals with the RE 81 and RE 95 codes described earlier qualify for fluoride varnish or other topical fluoride application beyond 20 years of age, in addition to the coverage of this service for all Medicaid members from the time of first tooth eruption to 20 years of age. As described earlier, individuals with IDD may have a number of reasons for difficulty maintaining oral hygiene, so the intermittent (usually biannual) application of fluoride varnish is an especially high-value intervention, whether delivered in a dental setting or in a primary care office or school-based clinic setting.
The treatment does not require sophisticated equipment or much time, and the technique is straightforward and should be painless. As such, other states have piloted efforts to allow parents and caregivers to apply the varnish at home, improving access for children and families, and freeing up dental clinics’ time and clinical resources that would be used for this straightforward intervention. Given the factors described earlier about challenges accessing office-based dental care for the population with IDD, the potential benefits of allowing caregivers to provide this service would be outsized.
Mobile, Portable, and Tele/Remote Dentistry
New York has a limited but important set of mobile and portable dental service models that bring care directly to people with IDD and others with difficulty accessing care in traditional dental settings. These programs deliver on-site preventive, diagnostic, and basic restorative services in settings such as schools, group homes, adult day programs, nursing facilities, and other community locations, often using portable equipment and, in some cases, teledentistry to support diagnosis, treatment planning, and referral. For individuals with IDD, bringing care directly into familiar settings can meaningfully reduce the friction that leads to delayed, interrupted, or missed care.
Examples documented by the Oral Health Workforce Research Center[lxxviii] include mobile and portable services operated through academic and safety-net systems such as Eastman Institute for Oral Health, which operates SMILemobile vans that have served the community since 1967. These specially equipped mobile units and wheelchair-accessible drivable clinics provide preventive, diagnostic, and restorative care to patients with developmental disabilities and complex medical needs at schools, nursing homes, and group homes, while serving as training sites for dental professionals in special needs care.
Finger Lakes Community Health combines portable dentistry with teledentistry and care coordination in rural areas, using community health workers to arrange care and achieve high treatment completion rates. NYU Langone Dental Medicine expands access for medically complex and special-needs patients through a large safety-net training network and school-based centers, with residents developing expertise in treating patients with unique oral medical challenges.
AccommoDental in Buffalo provides in-home dental care for patients with medical complexity, cognitive impairment, or physical challenges who cannot access traditional offices. The University at Buffalo School of Dental Medicine (S-Miles To Go) and Columbia University College of Dental Medicine (DentCare) both operate mobile clinics funded through the Mother Cabrini Health Foundation, serving special needs populations in rural and urban communities while training dental students in this specialized care.
New York Medicaid recognizes synchronous and asynchronous teledentistry encounter codes (D9995 and D9996, respectively) and reimburses for an originating site facility fee (Q3014), offering a payment pathway that can support remote triage and treatment planning in group homes, day programs, and other community settings. For individuals with IDD, teledentistry is particularly valuable as a triage and care-planning tool, by avoiding the need for a patient to travel to a dental office for what may amount to a preliminary visit with little or no physical care provided.
While these models demonstrate that mobile and portable dentistry can effectively reach individuals with intellectual/developmental disabilities and other high-need populations, their scale in New York remains constrained by limited reimbursement rates, workforce availability, and infrastructure and capital costs.67
Collaborative Practice Dental Hygiene
Collaborative Practice Dental Hygiene (CPDH) is a formal regulatory model that allows licensed dental hygienists to provide preventive and therapeutic services under a collaborative agreement with a dentist, rather than requiring direct supervision for each procedure. This model expands access by enabling hygienists to work more autonomously in community settings while maintaining clinical oversight and referral protocols. CPDH has been allowed in Article 28 facilities in New York since 2015; hygienists had to be employed by the facility and maintain a formal institutional relationship with that facility to practice without direct supervision.[lxxix]
In December 2025, Governor Hochul signed legislation amending CPDH-related law, significantly expanding CPDH beyond its original Article 28 settings. Effective June 2027, CPDH will be authorized in many more settings, including schools, federally qualified health centers, long-term care facilities, group homes for individuals with intellectual and developmental disabilities, State veteran facilities, shelters, and homebound patient settings. Rather than requiring institutional employment, the new model operates through written collaborative practice agreements between independent hygienists and dentists.
To practice as a Registered Dental Hygienist, Collaborative Practice (RDH-CP), hygienists must have three years of practice experience with a minimum of 4,500 hours and complete an eight-hour continuing education program covering medical emergency procedures, risk management, dental hygiene scope, and professional ethics. Collaborative practice agreements must be signed by the dentist, hygienist, and authorized setting, reviewed annually, include protocols for medically compromised patients and specific conditions, and require written patient notification that hygiene services do not substitute for dental examination.
By enabling hygienists to deliver routine preventive care independently across diverse community settings, CPDH has significant potential to improve access to oral health services, particularly for populations with barriers to traditional dental care, including individuals with intellectual and developmental disabilities. This expansion allows dentists to dedicate more time to complex cases while hygienists increase service availability in underserved communities, improving both access and affordability across the entire population seeking dental care.
IDD Non-specific Recommendations
The State should consider authorizing caregiver-administered fluoride varnish for eligible Medicaid members, with standardized training and reimbursement guidance, and continue expanding preventive fluoride delivery in other community settings where individuals with IDD already receive services.
The State should review reimbursement policies and regulatory requirements affecting mobile, portable, and teledentistry programs to ensure these models are financially and operationally viable in group homes, adult day programs, schools, and rural communities.
The State should also explore any available opportunities to increase reimbursement rates for other dental services, as this could increase the number of providers who participate in Medicaid.
Appendix A: Consolidated Recommendations
Training Recommendations
NYS oral health and IDD stakeholders (e.g., including OPWDD, DOH, NYS Oral Health Coalition, patient and caregiver groups) should determine 1) a centralized location to host and 2) which entities can help collate available, trusted training resources for all audiences in a user-friendly format, with translation options and full accessibility functions.
Potential topics for patients and caregivers include:
Information about eligibility for and support with pursuing relevant managed care exemption codes
Advocacy around caregiver home application of fluoride varnish
Availability of dental care in alternative settings
Potential topics for dental providers, including the dental professionals defined in Part I, as well as office managers and billing staff, include:
Eligibility requirements for OPWDD designations that correspond to enhanced rates
Clinical accommodations and workflow adaptations, including patient intake and communication methods, for more successful, efficient visits
Proper billing procedure for enhanced reimbursement mechanisms, including RE 95 and RE 81 designations and dental case management
Utilize available space to cross-market relevant public resources, such as by linking to the OPWDD eligibility process on the DOH Medicaid Dental website, to avoid the ongoing challenge of siloed information.
Promote dental professional students’ early awareness of and exposure to work opportunities caring for the IDD population, including by increasing formal education opportunities, investing in sustaining and growing specialized fellowships, and recognizing special needs dentistry as an ADA dental specialty.
Care Delivery Recommendations
OPWDD should communicate with leaders in Kansas to utilize their materials to incorporate features of the dental care passport into OPWDD’s existing pre-visit forms. In the long term, the State should explore how to utilize SHIN-NY infrastructure and the in-development OPWDD electronic dental record to automate data sharing between providers.
Individuals with IDD, their families, and caregivers should be informed of the available, free tools for communicating their needs with providers in advance, and dental providers should also understand how to incorporate them into visit planning.
Support FQHC and primary care providers in offering basic oral health services to improve “no wrong door” access for individuals with IDD.
Effectuate commonsense alignment of scope of practice laws, including to more accurately recognize the medical training of dentists, reflect the safety of administration of topical fluoride, and address other such incongruences.
Coverage and Billing Recommendations
DOH and OPWDD should collaboratively offer an educational webinar and publish an FAQ covering, on the consumer side – efforts required to be deemed eligible for the OPWDD managed care exemption codes, and – on the provider side, billing nuances and enhanced reimbursement rates for services provided to individuals with IDD, the dental case management code (D9997), as well as coverage of silver diamine fluoride application.
DOH should publish data to allow analysis of utilization of RE95- and RE81-specific billing codes in Medicaid dental claims, as well as data for dental claims at large through the All Payer Claims Database.
IDD providers should collaborate with dentists on flexible arrangements, so dentists who can occasionally practice in IDD-focused settings but are not familiar with Medicaid billing can provide their clinical services without the associated administrative responsibilities.
IDD-nonspecific Recommendations
The State should consider authorizing caregiver-administered fluoride varnish for eligible Medicaid members, with standardized training and reimbursement guidance, and continue expanding preventive fluoride delivery in other community settings where individuals with IDD already receive services.
The State should review reimbursement policies and regulatory requirements affecting mobile, portable, and teledentistry programs to ensure these models are financially and operationally viable in group homes, adult day programs, schools, and rural communities, and provide clear billing guidance for existing teledentistry codes.
The State should also explore any available opportunities to increase reimbursement rates for other dental services, as this could increase the number of providers who participate in Medicaid.
Appendix B: Data Request
The parameters of my data request to DOH:
Ideally, all of the following would be split by under 21 y.o./21 and over, to account for particular concerns about access for the pediatric and transitional-age populations.
It would also be ideal to know these statistics on an all-time and past-year basis, but past-year alone would still be helpful.
The number of NYS Medicaid members identified as IDD with RE code 95
The percentage of these members who had any dental visit
The percentage of these members who had a routine dental cleaning/exam (D1110 + D0150/0120)
The percent of members with IDD who received the allowed “extra cleaning” (D1110) more than two times in a year
The percent of members with IDD who received professional topical fluoride application (D1206 or D1208)
Utilization of D1354 (silver diamine fluoride to stabilize or treat early decay or difficult-to-treat decay) in this population
Utilization of D9222, 9223, 9239, 9243, 9230, 9248 (anesthesia, sedation codes) in this population
Utilization of D9430 (office visit for observation) in this population
Utilization of D9997 (dental case management) in this population
The percent of eligible visits that billed for the 20% fee enhancement to the APG base rate (i.e., rate codes 1501, 1489, 1435, and 1425)
Endnotes
[i] Dental Care in Medicaid Programs Workbook. American Dental Association Health Policy Institute. December 2025.
[ii] Composition of Ideal Dental Team. Harrington, C., Cole, J., & Kelly, J. Delaware Journal of Public Health. 8(5), 160–161. December 31, 2022.
[iii] Note: some requirements vary by state.
[iv] Dental Student Debt. American Student Dental Association.
[v] Some medical residents are represented by labor unions which may lead to different levels of benefits between represented and non-represented residents.
[vi] New York expands collaborative practice for dental hygienists. Nixon Peabody. January 8, 2026.
[vii] Authorization Status of Dental Therapists By State. Oral Health Workforce Research Center. April 2024.
[viii] Medicare Advantage Dental Benefits: Comprehensive Coverage Available In Fewer Than Half Of US Counties. Simon, L., Vujicic, M., & Nasseh, K. Health Affairs, 44(6), 693–701. June 2025.
[ix] Medicaid Member Dental Benefits. New York State Department of Health.
[xi] How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost. Cindy Mann and Adam Striar. The Commonwealth Fund Blog. August 17, 2022.
[xii] The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services. Congressional Budget Office. January 2022.
[xiii] Medicaid-to-Medicare Fee Index. 2024. KFF.
[xiv] Dental insurance isn’t a scam – but it’s also not insurance. Emily Stewart. Vox. Updated November 3, 2025.
[xv] Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. Silveira, E. R., Cademartori, M. G., Schuch, H. S., Armfield, J. A., & Demarco, F. F. Journal of Dentistry, 108, 103632. May 1, 2021.
[xvi] Why Are People Afraid of the Dentist? Observations and Explanations. Beaton, L., Freeman, R., & Humphris, G. Medical Principles and Practice, 23(4), 295–301. December 20, 2013.
[xvii] Dental Abscess. Sanders, J. L., & Houck, R. C. StatPearls. 2025.
[xviii] Hospital-Based Emergency Department Visits due to Periapical Abscess in the United States: Nationwide Estimates for the Years 2021–2022. Vogel, S., Ahn, G., Nalliah, R., Oubaidin, M., Han, M. D., Elnagar, M. H., Allareddy, V., & Lee, M. K. Journal of Endodontics. October 27, 2025.
[xix] National Dental Expenditures, 2023. American Dental Association Health Policy Institute.
[xx] State Oral Health Dashboard: State of Oral Health Equity in America Survey. CareQuest Institute for Oral Health. 2024.
[xxi] Consumer Survey Focused on Experiences Accessing Oral Health Services in New York State. Surdu S, Sasaki N, Pang J, Moore J. Center for Health Workforce Studies, University at Albany, College of Integrated Health Sciences. October 2024.
[xxiii] Ibid.
[xxiv] Ibid.
[xxv] Ibid.
[xxvi] Ibid.
[xxvii] Percent of Children (ages 0-17) Who had Both a Medical and Dental Preventive Care Visit in the Past 12 Months: 2023. KFF analysis of 2023 National Survey of Children's Health.
[xxviii] Dental Care Health Professional Shortage Areas (HPSAs). KFF presentation of data from Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services: Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2024.
[xxix] State Oral Health Dashboard: State of Oral Health Equity in America Survey. CareQuest Institute for Oral Health. 2024.
[xxx] Ibid, CareQuest analysis of Centers for Disease Control Water Fluoridation Reporting System.
[xxxii] Ibid.
[xxxiii] Ten Great Public Health Achievements: United States, 1900-1999. MMWR. CDC. 48(12);241-243. April 2, 1999.
[xxxiv] About Intellectual and Developmental Disabilities (IDDs). NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. November 9, 2021.
[xxxv] What is an IDD?. University of Rochester Medical Center Newsroom. July 11, 2024.
[xxxvi] Long-Term Supports and Services for Persons with Intellectual or Developmental Disabilities: Status and Trends Through June 30, 2020. Larson, S. A., Neidorf, J., Begin, B. C., Pettingell, S., & Sowers, M. University of Minnesota, Institute on Community Integration. 2024.
[xxxvii] OPWDD By The Numbers. New York State Office for People with Developmental Disabilities. December 2025.
[xxxviii] Heterogeneity in age at death for adults with developmental disability. Landes, S. D., Stevens, J. D., & Turk, M. A. Journal of Intellectual Disability Research, 63, 1482–1487. 2019.
[xxxix] ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities. Lagu, T., Haywood, C., Reimold, K., DeJong, C., Walker Sterling, R., & Iezzoni, L. I. Health Affairs, 41(10), 1387-1395. October 2022.
[xl] Access to Dental Services for Adults with Intellectual and Developmental Disabilities. Medicaid and CHIP Payment Access Commission (MACPAC). June 1, 2025. p. 5.
[xli] This Has to Change – A Mother’s Quest on Behalf of People with Disabilities. University of Rochester Medical Center Newsroom. October 23, 2025.
[xlii] Bridging the Dental Care Gap: Addressing Oral Health Disparities in New York State Nursing Homes. McIlduff, S., & Phulgirkar, A. The New York State Dental Journal, 91(1). January 1, 2025.
[xliii] Oral Health in America: Who Gets Left Behind? Heaton, L., Cheung, H., O’Malley, J., Santoro, M., Preston, R., Sonnek, A., & Tranby, E. CareQuest Institute for Oral Health. November 5, 2025.
[xlv] Individuals who lose their teeth may be appropriate candidates for dentures, though these may pose a choking risk and are not suitable for all. Dental implants may be a solution for loss of some teeth, although this solution can be cost-prohibitive.
[xlvi] Optimizing Dental Care for Adults With Intellectual and Developmental Disabilities: Challenges, Strategies, and Preventative Approaches. Sachse, C., & Jacob, R. Cureus. University of Florida College of Medicine. November 2, 2024.
[xlvii] An overview of dentist–patient communication in quality dental care. Ho, J. C. Y., Chai, H. H., Luo, B. W., Lo, E. C. M., Huang, M. Z., & Chu, C. H. Dentistry Journal, 13(1), 31. January 14, 2025.
[xlviii] Access to Dental Services for Adults with Intellectual and Developmental Disabilities. p. 2.
[xlix] Dental Anesthesia/Sedation Certification. New York State Education Department.
[li] Policy on Transitioning from a Pediatric to an Adult Dental Home for Individuals with Special Health Care Needs. American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:185-8.
[lii] The Doctor is…Out: Shortages of Health Professionals in Rural Areas. Office of the New York State Comptroller. August 25. p. 13.
[liii] Professionally Active Dentists by Specialty Field: 2024. KFF, using data obtained from the American Dental Association through a special data request. 2025.
[liv] Addressing Barriers to Oral Health and Health Care for Adults with Intellectual and Developmental
Disabilities in New Jersey, Five-Year Plan. Koball, H., Setty, S., Ahluwalia, K., Fosse, C. Columbia College of Dental Medicine and the National Center for Children in Poverty, Bank Street College of Education. March 2020.
[lv] Dental access and expenditures for adults with intellectual and other disabilities. Fosse, C., Luo, H., Laniado, N., Okunseri, C., & Badner, V. Journal of Public Health Dentistry, 81(4), 299-307. October 25, 2021.
[lvi] Report to Congress on Medicaid and CHIP June 2025. Chapter 1: Children and Youth with Special Health Care Needs Transitions of Care. MACPAC. June 2025. p. 18-22.
[lvii] Accreditation Standards For Dental Education Programs. Commission on Dental Accreditation. Revised August 8, 2025. p. 31.
and Developmental Disabilities. National Council on Disability. April 5, 2023. p. 63.
[lix] Smiles United Dental Initiative Celebrated During National Children's Dental Health Month. February 14, 2024.
[lx] Special Care Dentistry. General Dental Council U.K.
[lxi] Special Needs Dentistry: Interdisciplinary Management of Medically-Complex Patients at Hospital-Based Dental Units in Tasmania, Australia. Lim, M. & Borromeo, Gelsomina. International Journal of Medical Research & Health Sciences. 2017. 6(6), 123–131.
[lxii] My View: Special care dentistry should be the next dental specialty. Joshua Walker. ADANews. May 8, 2023.
[lxiii] Dental fellowship serves special needs patients. Jacob Schermerhorn. Rochester Beacon. September 29, 2025.
[lxiv] Response to 5.07 Plan. NYS Developmental Disabilities Advisory Council.
[lxv] Access for All Smiles: Dental Visits. McMillen Health. 2023.
[lxvi] Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis. National Council on Disability. March 9, 2022. p. 56.
[lxvii] My Dental Care Passport. Oral Health Kansas.
[lxviii] Governor Hochul Announces $25 Million to Expand Access to Health Care for People With Developmental Disabilities. New York State Office of the Governor. September 25, 2025.
[lxix] Chairside Diabetes Screening: A Survey of Dental Providers at the Largest Municipal Healthcare System in the United States. Laniado, N., Cloidt, M. A., & Badner, V. M. (2021). Oral Health & Preventive Dentistry, 19, b2448635. December 18, 2021.
[lxx] Interdisciplinary oral and primary health care for patients with disabilities. Etminan, S., Hammerdahl, E., Lesondak, L., Li, N., Patel, M., Mischler, M., Keehn, M., & Kirschner, K. Frontiers in Medicine, 12, 1619845. July 16, 2025.
[lxxi] Transforming Transition in Dental Care for People with Disabilities. Chelsea Fosse et al. November 3, 2025.
[lxxii] Access to Dental Services for Adults with Intellectual and Developmental Disabilities. p. 1.
[lxxiii] Implementing a Medicaid Dental Benefit for Adults with Disabilities Can Yield Significant Cost Savings. Texas Health Institute. February 2021.
[lxxiv] New York State Medicaid Policy and Procedures, 2025. p. 75.
[lxxvi] Fluoride varnishes for preventing dental caries in children and adolescents. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Cochrane Database of Systematic Reviews. (7). 2014.
[lxxvii] Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia. Scherrer, C., Naavaal, S. The Journal of Pediatrics. 212, 201-207. September 2019.
[lxxviii] Compendium of Innovations in Oral Health Service Delivery. Oral Health Workforce Research Center. Center for Health Workforce Studies. University at Albany, School of Public Health. February 2020.
[lxxix] The Practice of Dental Hygiene Pursuant to Collaborative Arrangements. New York State Education Department Office of the Professions.