Nicole McGrath-Barnes, DDS, FACD, is Founder and CEO of the KinderSmile Foundation, a member of the Quality Institute’s Consumer Council. Dr. McGrath-Barnes serves on the Advisory Council of the Quality Institute’s Medicaid Policy Center.
You were a dentist in private practice and the Program Dentist for Montclair Child Development Center, a Head Start program, when you founded KinderSmile. Why did you create this non-profit organization to advocate for at-risk children who lack access to dental care?
In 2007, I received a phone call from my dental receptionist on one of my days off. I was home with my kids, and she said, “Oh, there’s a little five-year-old girl here to see you.” And I said, “It’s my day off.” The girl’s great aunt was with the child, who was in real pain. So I went to my office, and this five-year-old little Black girl had a swelling on the lower right side of her mouth the size of a golf ball. The great aunt said she could not find a dentist who would take the family’s Medicaid insurance.
So here I am leaving my kids, my African American kids — my son was almost the same age as this girl — and I got a pit in my stomach. This child had an abscess, which can be deadly if the bacteria spreads to the head and neck. I immediately started her treatment and said bring her back after 10 days to have that tooth extracted.
I went home that day and I looked in the eyes of my own kids. That night, I fell to my knees in tears, asking, “What am I doing in this profession?” And that’s when the Lord spoke to me about being a voice to make sure that there is access to dental care for all, the uninsured and the underserved. That night KinderSmile Foundation, a 501(c)(3) nonprofit, was born.
And to confirm my path, soon after, I saw on the front page of a dental publication a story of a 12-year-old Black boy, Deamonte Driver from Prince George’s County in Maryland, who died of the same infection. The mother buried her first child because no one wanted to treat him because he had Medicaid.
What can you tell us about KinderSmile’s more comprehensive approach to dental services?
Part of that comprehensive approach is our education, intervention, and prevention. Getting a tooth extraction or filling or anything like that is the icing on the cake. We also must educate and intervene. We’re talking about the number one preventable disease here. We partner with Head Start programs, WIC programs…perinatal programs to educate people about oral disease and link them to a dental home for continuity of care.
Although NJ Family Care (New Jersey’s Medicaid Program) provides dental coverage to adults and children, many dentists do not participate in Medicaid. Can you suggest ways to attract more dentists to provide care for people insured through Medicaid?
People covered by Medicaid must sign up with a Managed Care Organization, or MCO. Although New Jersey’s fee-for-service Medicaid rates are the highest in the nation, those are not the rates that the MCOs actually pay to dentists who participate in Medicaid. For instance, the Medicaid listed fee-for-service rate is $37 for an examination, but the MCOs on average actually pay $16. Only about 26 percent of dentists in New Jersey accept Medicaid through an MCO, the 9th lowest in the nation. The overhead of dentistry is so high it’s not worth it for the dentist to take the Medicaid MCO rates.
What we need to do is increase the reimbursement the MCOs provide to dentists to make them match the listed fee-for-service rates. We also need to simplify the credentialling process. Right now, a dentist needs to do back flips to be credentialed with Medicaid MCOs. Access to high quality dental care is a real problem in areas such as Trenton, where I see patients.
How is dental health related to healthy pregnancies and babies?
Sixty percent to 75 percent of pregnant mothers have gingivitis due to the hormonal imbalance. Untreated gingivitis during pregnancy can progress to periodontal disease or periodontitis, which can trigger premature delivery. Lack of access to care is a reason we have a high-percentage of low-birth rate babies in New Jersey among the Black and the Brown community. You can go to your OB-GYN and take your perinatal vitamins, but if you don’t address oral disease, you could still potentially deliver prematurely because of the acid-loving bacteria in periodontal disease and gingivitis. We are partnering with First Lady Tammy Murphy on her Nurture NJ Maternal and Infant Health Plan and stressing that all pregnant individuals get an oral health assessment. We educate them on oral disease, prevention, recreational drug use, and nutrition for three and a half hours. Then they transition to one of our dental homes, and they get one year’s worth of free dental services, up to a $1,500 credit. The mother becomes an ambassador in their community for oral disease prevention.
Where might we see you on a day off?
I love bicycling. And I love, love gardening. I love nature and strolling along the water. Anything involving nature.