Episode 14 - 20 YEARS OF GROWTH AND INNOVATION: THE EVOLUTION OF VIRGINIA'S MEDICAID DENTAL PROGRAM

In this episode, we are joined by VDA Member, Dr. Zachary Hairston, who serves as the Dental Consultant for Virginia's Cardinal Care Smiles Dental Program, and Justin Gist, Dental Program Manager at the Virginia Department of Medicaid Assistance Services. They discuss the 20-year evolution of Virginia's Medicaid dental services, from its initial focus on pediatric care to the recent inclusion of pregnant members and adult comprehensive dental benefits. The conversation covers the impact of these changes, the challenges faced by providers, and the initiatives undertaken to ease those challenges, including fee adjustments, administrative streamlining, and the importance of patient education. They also emphasize the vital role of the Dental Advisory Committee in shaping the program and the need for ongoing advocacy and participation from dental professionals to ensure the program's continued success.

HOST: Paul Logan: Paul is the Director of Strategic Initiatives/Innovations at the Virginia Dental Association. He focuses on member advocacy, developing resources for dental students and early-career dentists, and working with a broad array of stakeholders to address and elevate Virginia’s dental workforce needs. 

GUEST(S): Dr. Zachary Hairston: Dr. Zachary Hairston has over 40 years of experience as a dentist, beginning his clinical practice in Danville, Virginia. He graduated from the Virginia Commonwealth University (VCU) School of Dentistry in 1983 and received further study from the United States Dental Institute and Gerety Orthodontics. Since 2015, Dr. Hairston has served as the Dental Consultant with the Virginia Department of Medical Assistance Services (DMAS) Medicaid Smiles for Children (SFC) program. In this capacity, Dr. Hairston oversees all clinical aspects of the SFC program, which now includes comprehensive dental care for adults. Dr. Hairston also serves as the VDA Dental Medicaid Benefits Liaison. 

Justin Gist: Justin serves as the Dental Program Manager for Virginia’s Medicaid dental program, Cardinal Care Smiles, where he leads contract management, policy development, and oversight of the state’s dental benefits administrator. In this role, he works closely with providers, community partners, and state leaders to strengthen network adequacy, expand access to care, and ensure compliance with federal and state standards. Justin is deeply committed to workforce development, innovative strategies to reach underserved populations, and building sustainable provider participation across Virginia. He played a central role in advancing comprehensive Medicaid dental benefits, extending coverage from children to pregnant individuals and adults. Justin holds a bachelor’s degree from Virginia Commonwealth University and a master’s degree from Barry University, bringing a strong foundation in leadership and health program administration to his work.

MENTIONED IN THIS EPISODE: VDA Dental Medicaid Benefits Liaison: https://www.vadental.org/vda-dental-medicaid-benefits-liaison

EPISODE CREDITS:

Producer/Host: Paul Logan

Guest(s): Dr. Zachary Hairston and Justin Gist

Post-Prod

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Music in this episode from Epidemic Sound

Transcript

[00:00:10] Paul Logan: Welcome to another episode of The Fulcrum a Virginia Dental Association podcast. My name is Paul Logan. I'm the Director of Strategic Initiatives with the VDA. I'm very pleased to be joined today by Dr. Zachary Hairston, who currently serves as the dental consultant for Virginia's Cardinal Care Smiles Dental Program. And Justin Gist, the Virginia Department of Medicaid Assistance Services Dental Program Manager, Dr. Hairston. Justin, welcome.

[00:00:36] Paul Logan: Thank you. Thanks Paul. 

[00:00:39] Speaker: We're marking an anniversary this year. 20 years ago, DMAS carved out Medicaid dental services from traditional medical plans, creating a separate dental benefit, specifically designed to better meet the needs of both children and adults. I wonder if to open if each of you could share some reflections on how this program has evolved since its launch in 2005 and where you see it going, starting with you, Dr. Hairston.

[00:01:02] Dr. Zachery Hairston: Yes. Yes. I'll be happy to. And thanks to you and the VDA for hosting this podcast. When we began in 2005, the focus was on, the zero to 20 population pediatric dentistry and everyone's heart was in the place of wholesome and comprehensive care. What was happening in Virginia was happening across the country, and there was this strong need there should be comprehensive dental care, and especially so for all of the kiddos, they need to have this care.

[00:01:40] Dr. Zachery Hairston: We grew from pediatric care to making sure that this involved young adults, so it's easy to talk about it as the zero to 20 population that care continues to function very well. There's quite a number of pediatric dentists involved, a number of specialties, specialty dentistry, dentists that are willing to see the pedos.

[00:02:04] Dr. Zachery Hairston: And in 2015, we brought on the pregnant member benefit. The first year that benefit was in operation there were 2300 folk that were seen, 2300 pregnant members. In 2024, that has quickly gone to 8,600 folk in any given year, and in 2025 we are on track to have just under 10,000 pregnant members that will be seen this year.

[00:02:38] Dr. Zachery Hairston: So far year to date, we've seen 4,300 pregnant members. Then in 2021, we brought on adult dental. A comprehensive all specialties provided program. And in bringing on this program the agency director was keen to say, we cannot increase the cost of benefits, right now. We can't increase the dental code procedures benefit amount, so we are gonna have this program with no annual maximum, no deductible and no copayments. And that still happens to be the case. We've done tremendous strides since 2021 and as of 2021 from June to July in one day, one night. The adult dental benefit became available to 900,000 members. Overnight. And they've got comprehensive dental coverage with the benefit structure that I've just mentioned. Now, I'm optimistic to believe we can have even more growth. We must, however, enlist more providers to come on board. 

[00:04:01] Paul Logan: Thank you, Dr. Hairston. And the evolution is an important thing that has happened is the program has grown as you said, being able to serve more patients in Virginia. Looking back, I think since 2021, we've added almost 500 providers, which reversed, what would've been a few years of decline before that. And it's important to have them in, but also that those providers who are in are taking new patients and we're addressing any issues they have with being able to see more patient. Justin, I wonder if you could share, share just some of your thoughts on on where we are, what the future holds for the Medicaid program.

[00:04:41] Justin Gist: Yeah, thank you again Paul and the VDA for giving us this opportunity. We've seen remarkable changes over the past 20 years. My vantage point is a little bit different in that I've only been in this assignment since, 2021. But I do realize the advancement of oral health in 2005 with our zero to 20 population. 2015 with our pregnant members. And then 2021 with the adult coverage. This program really shifted the paradigm and has transformed the lives of so many Virginians from working adults that are now able to get out of dental pain and return to the workforce, to seniors who can eat, smile and really speak with confidence.

[00:05:24] Justin Gist: We've also built a strong partnership, that includes providers, managed care organizations, our Dental Benefits Administrator, DentaQuest, advocacy groups, clinical experts. We're all working together to really just ensure that our members have access to quality care.

[00:05:41] Justin Gist: And looking ahead, to the future our vision is really bold. Dr. Hairston spoke about workforce, so expanding the number of participating Medicaid providers, especially in those underserved regions like Southwest Virginia. That's really a top priority for us. We'll continue to work closely with you all at the VDA. The School of Dentistry at VCU, Virginia's Hygiene Programs and other partner is really to promote workforce pipelines.

[00:06:07] Justin Gist: Another big thing that we're looking at is oral systemic integration. So, we're aiming to move towards stronger integration of dental with medical care. So particularly looking at individuals with chronic conditions like diabetes, and populations like pregnant members and adults as well. Really looking at how we can integrate oral health into a members' overall health and wellbeing. We have a case management and a care coordination program that allows for collaboration between DentaQuest, our dental benefits administrator and the members MCO to really ensure whole body focused care.

[00:06:43] Justin Gist: We want to essentially improve member engagement and oral health literacy as well. So, we recognize coverage is just not enough. So, members really need to understand the importance of oral health and how to use their benefit when and where to seek care. We're working to launch member center outreach campaigns, especially for adults and pregnant members.

[00:07:05] Justin Gist: So, we have a social media campaign that we're running the month of October, that really highlight the dental benefit, for children, pregnant members, and adults. And then finally just enhancing policy innovation. We participate in several national collaboratives, and research with, CareQuest and our Medicaid State Dental Association.

[00:07:26] Justin Gist: And that really helps to shape the Medicaid dental policy at both the state and the federal level. We recognize, the strides that we've made over the last few years and, I'd be remiss if I didn't take the time to, to recognize Dr. Hairston, and the work that he's done with the program.

[00:07:42] Justin Gist: We're excited about the future ahead. 

[00:07:44] Paul Logan: Thank you Justin. Something you, you mentioned in there about patient education is so important, both that they know about the benefit, how to use it and having the right expectations as they're seeking care and understand how that will work. I think that's something that is good for the dental practices So, so they, they are working with patients who have a, have a better baseline understanding and it's wonderful to hear. I've been at the VDA for about five years and something I've, I've been very impressed with since I had a chance to attend them are the Dental Advisory Committee meetings that are held on a regular basis where you bring in folks from DMAS folks from DentaQuest and dentists include VDA leadership from around the state just to, on a semi-annual basis, look at what's working, what are we hearing and putting in steps to be responsive to that. Can you all talk just about how the Dental Advisory Committee works and where you see that going. 

[00:08:49] Dr. Zachery Hairston: Yes, and thanks for this question. I'm proud to be able to say that I'm one of the legacy members of the Dental Advisory Committee and wish to give just a little bit honor to some of the other legacy members that are still on board with the Dental Advisory Committee.

[00:09:04] Dr. Zachery Hairston: Dr. Dickinson, Dr. Adams, Dr. Atkins, Dr. Southern was there early on. Dr. Brader with the Virginia Department of Health. And I'd also like to give a little bit of a kudo to Chuck Duvall. Chuck Duvall has been a part of Dental Advisory Committee since the very beginning. Let me just say in those first meetings, we knew that we were on to something.

[00:09:31] Dr. Zachery Hairston: The agency director then was Pat Finnerty sitting at the head of the table was also our current agency director, Ms. Cheryl Roberts. And some 15 to 20 dentists came together and there were other stakeholders. To say we want to create a top shelf program for this state. Now this was for Pedos at that time it was for pediatric dentists, and the meetings were quite spirited, on some occasions. Now we were meeting then more than just twice a year. We were meeting every other month, sometimes a couple of months we had a couple of meetings, more than a couple of meetings. There was representation from all across VCU was represented. The pediatric department at VCU was represented. Many of the specialists throughout the state was represented. Dentists from all of the state were traveling in. They were coming from Southwest Virginia, Northern Virginia. There were some dentists coming in from outta state to be a part of these meetings, there was private practice dentists and there were state organizations that had dentists that was contributing also. - It was brought with other stakeholders. There was a committed group of 20, maybe a few more people in this room, and we were hashing out from a very fundamental and ground level how we were going to make this program work.

[00:11:02] Dr. Zachery Hairston: We hadn't come up with who the dental benefits administrator was going to be. What we did know is we wanted to centralize this. Many of the patients that were going to dental offices, and I was a practicing dentist accepting Medicaid at that time. We're going back 40 years ago now that I've been a Medicaid provider.

[00:11:24] Dr. Zachery Hairston: But many of the patients or the parents were going to dental offices and they would say who's your insurance company? Or who do you have? No one could definitively say. So, we knew one of the things that was a requirement is we had to make this one dental benefits administrator for the program for the state.

[00:11:47] Dr. Zachery Hairston: Everyone had buy-in. And what happened. We would leave the meetings and carry this discussion, carry this focus back to our neighborhoods, back to our different parts of the state, and it would be many voices leaving the meetings going into the different communities, and it still works today.

[00:12:08] Dr. Zachery Hairston: The Dental Advisory Committee now meets two in-person meetings per year. And we've got two mini-DAC meetings that we meet virtually that we are still working toward. Now lastly, I will say, this Dental Advisory Committee has become a model for other states. We get calls, how do y'all do this? How did it work? And I'm proud to say Justin and I both give up our time to speak with other states about this. 

[00:12:40] Justin Gist: And just to piggyback off what Dr. Hairston has said the DAC is truly been the heartbeat of stakeholder engagement for our program. It serves as a vital forum for clinicians, for advocates and for oral health leaders.

[00:12:55] Justin Gist: It's really come together and provide real-time feedback on our program. It's one thing to design a policy at the agency level it's another thing to hear directly from the folks on the front line. The dentists that are treating our members the hygienists in school-based settings the organizations like the VDA like the Catalyst who do so much for policy accuracy.

[00:13:17] Justin Gist: Over the years the DAC has really helped us shape everything from clinical policy changes and benefit to design, to claims, processing issues, credentialing improvements and even member outreach strategy. The DAC also plays an important role in accountability. DentaQuest, who's our dental benefits administrator, attends those meetings.

[00:13:38] Justin Gist: They provide updates, they listen to concerns, and they respond directly to the provider community. That kind of transparency is critical and the DAC and shows that it happens consistently. And Dr. Hairston spoke about this, but one of the things I really appreciate about the DAC is that it's not just a quarterly meeting it's a working partnership.

[00:13:57] Justin Gist: Dr. Hairston and I both, we've personally reached out to several providers who are SMEs in certain areas and say, hey we have an issue. We have an idea. And we need your expertise. And they jump into action. We are excited about where the DAC is going. Dr. Harrison mentioned the mini-DACs as well. But again, the DAC is instrumental in, in what we do and how we do things in the state of Virginia for Medicaid dental. 

[00:14:23] Paul Logan: Thank you both for that. For the next session. I wonder if we could go through some assumptions we sometimes hear from members as the VDA and address each of those one by one. As you all both laid out the Medicaid program has changed. The benefit has changed, adding pregnant members in 2015, adding the full adult benefit. The comprehensive adult benefit. And then over the last few years adding I think a combined 34% increase in the reimbursement rates for Medicaid. I was wondering could you just starting with that first, something we hear is. From members who either are not participating or are frustrated, it is reimbursement rates. And this is not unique to just Medicaid. It's a common issue that we hear from members, but I wonder what you could say to them who are saying reimbursement rates are too low to make it worth participating in another insurance plan. My practice is busy. 

[00:15:27] Dr. Zachery Hairston: Yeah, we hear that now. We still hear that. Since 2022, you're right, there has been a 30% increase and then an additional 3% increase. If we were to think about something I mentioned earlier, this plan that we are speaking about today has no copayment from the patients, no annual maximum of the treatment that can be done. No deductible that the patient has to pay when they get to the front desk. And we built into this program something that Justin mentioned earlier. Oral health equaling overall health. We built into this adult dental program from the beginning up to three cleanings a year in an effort to do more work toward whatever gum treatment that can be done. So, when we hear the dentist say about the fees being too low, we'll ask that you take a look at it again, because there are not many commercial insurance programs that are gonna say the patient doesn't have to pay some type of deductible. That there's no annual maximum.

[00:16:47] Dr. Zachery Hairston: That's the new Medicaid we want people to think about. And I'll just speak to the fees now and to let Justin weigh in. Then we'll talk about some of the other ideas about. What the program has been over the years. So, I'll pause on that. 

[00:17:05] Justin Gist: And just to piggyback again off of Dr. Hairston, you know what he said? In the most recent HPI study we're number 12 in the nation when we look at reimbursement percentage compared to private insurance, so we're currently around the 82 percentile in reimbursement when compared to private insurance. Again, Dr. Hairston has really reiterated we are truly comprehensive in what we cover. In that we cover each of the dental specialties for children and we cover each of the specialties outside of ortho for pregnant members and adults. He touched on the no copay touched on the no yearly max. Actually, I had a conversation with a provider in Southwest Virginia, and she called me, and she said Justin, you all reimburse higher for certain CDT codes that we use often in our practice, higher than some of the private insurances.

[00:17:59] Justin Gist: I really encourage providers who aren't participating to take a look at the new fee schedule. And if you have any questions, reach out to us. One of the things that we pride ourselves on is we're certainly amenable to traveling. We go all over the state speaking to providers, speaking to offices. Any concerns about anything related to fees or office policies? Please reach out to us.

[00:18:24] Dr. Zachery Hairston: Paul, if I can. I'd to, I'd like to speak to this very fee issue. Something the dentists can carry away with tomorrow. Something the dentist can hear about today and see how this works real time. And I'm speaking from myself, being in the office, in the private practice, treating patients. Okay. There would be times even not just with Medicaid insurance, but any other insurance, I would say to the patient, but your insurance doesn't cover this.

[00:18:55] Dr. Zachery Hairston: That doesn't happen now with our new program. The two things we don't cover for adults are braces and bridges. We cover hygiene, we cover perio at a high level. We cover endo, extractions, dentures. Dentures can be done on the very first appointment, partials and certainly surgery. Now, there was a time when the dentist would be right beside the patient, myself included, and said, Ms. Smith, but your insurance doesn't cover that. That doesn't happen with the program we got there except the two benefit two occasions I mentioned. Orthodontics for adults, we cover orthodontics for young folk. But not for adults and bridges. We cover bridges for young folk, but not for adults. We cover crowns for adults. Now the dentist doesn't have to say, but your plan doesn't cover that. When the patient leaves and goes to the front desk to check out, the front office doesn't say to them, but Ms. Smith, your payment today is you haven't met your deductible. Those things don't happen with our program today. 

[00:20:03] Paul Logan: Thank you for that. Another thing we have heard from members and I'm sure you all have heard as well, is it takes too long to deal with the paperwork, bureaucratic hurdles, frequent audits, burden for front office and dealing with just more requests for appointments than a practice can reasonably accommodate.

[00:20:22] Paul Logan: I would love to hear about some of the initiatives that you all have shared at recent DAC meetings. And just the progress has been made and how someone who might have had that perception from 10 or 15 years ago, what has changed. 

[00:20:35] Justin Gist: Yeah, that's a great question, Paul. We've took steps to streamline credentialing by now accepting the CAQH application. This is a standardized electronic credentialing form that allows dentists to submit all of their credential information to a single source. So, if a new provider wants to credential for our program, and let's say two other private insurance, they can fill out this one CAQH application for all three insurance programs.

[00:21:01] Justin Gist: We've reinstated our broken appointment program which aims to prevent broken appointments by really collaborating with our dental providers to track members who either fail to show up for their appointments without notice or cancel without 24 hours notice and don't reschedule.

[00:21:17] Justin Gist: Providers in our program have the option to submit one of two CDT codes to DentaQuest on the ADA claim form. And once this happens, DentaQuest provides outreach to the member and helps reschedule the appointment if necessary. 

[00:21:32] Justin Gist: I spoke about the case management and care coordination program earlier. That's been extremely instrumental in our program. This program is really created to care for members who have special healthcare needs and barriers with access and dental care. Once a member is Identified as someone who has a special healthcare need. We really reach out, and we do person-centered care for that member.

[00:21:59] Justin Gist: So, this can be anything from helping the member find the right dentist who can provide care based on their need all the way to creating a plan of care that involves connecting with with case workers, caregivers, medical providers, mental health providers, and community resources really to ensure that the whole member is cared for.

[00:22:17] Justin Gist: So, the case management and care coordination program is really improving health outcomes by just ensuring that the member has received all the support and education that they require to really have ongoing source of care really appropriate to their needs.

[00:22:32] Justin Gist: We hear the concerns. And one of the things that we pride ourselves is we listen and then we implement changes really to help on the front end for practices that participate in our program.

[00:22:43] Paul Logan: Another thing we have also heard, and I think you touched on some of this just now, is Patients who come into a practice with just unreasonable expectations about what a dentist can do for them, expecting something to be done in one visit that might take several visits. What is DMAS and DentaQuest doing to help just address that patient education piece. 

[00:23:08] Dr. Zachery Hairston: Yeah, that's an important piece. And it's also important to realize, as I said earlier that day between June and July 900,000 new adults became eligible. They've been sitting in discomfort and wanting treatment for some time.

[00:23:31] Paul Logan: Right.

[00:23:32] Dr. Zachery Hairston: And they know that the benefit is available, but they don't know the depth of the structure of the benefit like the dental offices will know. What has DMAS and DentaQuest done? There's been much literature that's been sent out to speak to that. And Justin can get into that a little bit.

[00:23:54] Dr. Zachery Hairston: But let me get back to the clinical side of the dentist to patient relationship. There's gotta be some education from the dentist to the patient. Now that you have this benefit, let's get into getting your cleanings done on a regular basis. When you leave, go ahead and schedule appointments.

[00:24:13] Dr. Zachery Hairston: The front offices and the dentist are willing to work with the patients, but they have to be guided some. As to what needs to happen on their part. And let me just touch upon something that we hear that you might speak of as well. When it comes to guiding broken appointments. Patients of all level for whatever insurance company they might have need to be guided on how they should keep their appointments and what should happen here is the front office, again, real life, this worked in my office, the front office and the dentist need to look the patient in eye, the adult in eye, and say, Ms. So and so, you have a top shelf program here. There are many people that would like to have your appointment, keep your appointments.

[00:25:06] Dr. Zachery Hairston: When they get to the front office, my office manager would say to them, Mr. Smith, I'm gonna make this appointment. I'm gonna call you the day before. We want you to keep it. If you can't keep it, let us know. So, there's a form of education that has to happen. Even with adults.

[00:25:24] Dr. Zachery Hairston: They don't know how to properly care for their teeth because some of them haven't been in 10 years. So, there's gonna be a lot of hygiene production that's going to come outta this program with the availability of three cleanings a year. 

[00:25:39] Justin Gist: Yeah, absolutely. And also, we have a Dental Champions Committee that's led by Dr. Hairston and Dr. Terry Dickinson. And this is a rather new committee in our program.

[00:25:50] Justin Gist: And the committee is really comprised of Medicaid providers from diverse practice settings and specialties. And they represent various regions across the state. And part of that committee's framework is to share their experiences with the program. And how the program works in their practice.

[00:26:06] Justin Gist: Look for more information to come about the Dental Champions Committee uh, which will also help alleviate some of the myths that we're speaking about as well. And then finally and I touched on this earlier myself and Dr. Hairston we're here as a resource, so we pride ourselves in helping providers in this program to ensure that they're comfortable with the program, our benefit structure, and reimbursement methodology.

[00:26:28] Justin Gist: I say this all the time. Dr. Hairston and I will be in the meeting and he'll say. Gotta run, Justin. Dr. So and So is calling me about an issue. We're here for our members, the providers in the programs. I may be a little off here, but I don't believe that you can pick up a phone and call the program manager or the clinical consultant's cell phone at a private insurance. We give providers and offices that ability to do so because we want to help ensure that they're really supported in our program. 

[00:26:55] Paul Logan: Thank you Justin. My, my next question actually touches on that personalized service. Last year we were talking after one of the DAC meetings. And through that we are discussing issues that, that you were hearing from providers frustrated by delayed payments, non-payment for services rendered.

[00:27:15] Paul Logan: And we launched the VDA Dental Medicaid Benefits Liaison, which is a process that the VDA members can go through and essentially go directly to you, Dr. Hairston to present the facts of their circumstances and have a second pair of eyes on what either their denial or delay and help them find out what's going on.

[00:27:41] Paul Logan: And can you talk a little bit about that personalized service and how you are able to help members who are experiencing something. 

[00:27:49] Dr. Zachery Hairston: Yeah. And thanks for this question. You're playing my hand because I was hoping you would go here. I am very happy to have this relationship with the VDA, and it goes under head and of a VDA liaison.

[00:28:03] Dr. Zachery Hairston: There are instances, even when the office reference manual, which is the manual for the program, even when the office reference manual is followed, the dentist has done work that seems a bit out of line as to what we have in print. Okay. Now the dentist has done the work, and the manual is created based upon how we expect the program to run. But work is done outside of the manual, and it's done just as, for instance. The manual speaks about a restoration not being doable within a certain timeframe, but the restoration broke. And it broke because of various reasons, or it had to be replaced for various reasons. What I will do, and Justin says this, Justin spoke to this. When dentists will reach out to me by way of email, and there's the whole program is mentioned in one of the VDA journals. By way of email to say, would you take a look at this? I did it. Now the member has to have coverage at the time. They've gotta be a patient of the Medicaid program. And I'm willing to look at every time that a dentist will write to me and say, take a look at this. We are out of what it says in the office reference manual, but I want you to look at it. We did the work, the patient is fine, X, Y, Z. 

[00:29:29] Paul Logan: Thank you Dr. Hairston. And we will include that email in the show notes for this podcast. The email is CardinalCareSmiles@DMAS.virginia.gov. My la last question on this topic. Things we hear from members, many practices are short staffed, find it difficult to schedule in their current recall patients in a timely manner. What would you say to those who are already struggling as to how they can incorporate participation in Medicaid into their practice? 

[00:29:58] Justin Gist: Really good question. And this is very real, right? Especially in today's staff and climate. What we tell providers is you don't have to overhaul your entire practice to participate.

[00:30:09] Justin Gist: So even seeing a small number of Medicaid patients can make a meaningful difference. So, we have a Take 10 program where we encourage our providers to take 10 new families into their practice. We've also seen some providers focus on special populations that they're passionate about. So that may be seniors, members with intellectual or developmental disabilities, pregnant individuals, et cetera. Every additional provider we bring on, even for a small number of appointments, expands access and reduces wait time system wide. We talked about the Dental Champions Committee. I spoke about that earlier. As this committee gets up and running, it'll be instrumental in coordinating with providers in the area to really find best practices for our program based on the member population in their area because that matters, right? Members and providers in Northern Virginia deal with a certain set of things that may be different than members in Southwest Virginia. And then, and I bring it up time and time again, but Dr. Hairston are always, Dr. Hairston and I are always happy to help alleviate any office specific barriers that arise as well.

[00:31:15] Justin Gist: You gave the email address, so please, if you have any questions, any concerns about how can I structure my practice to be successful in Medicaid, please reach out to us. 

[00:31:26] Dr. Zachery Hairston: Let me also say, I would say to a dentist, take some help out in some way. Not to the point that you feel like it overloads your staff or overloads you. If you want to test the waters. Take some. When we first began the program back in 2005, there was a mantra that we used it was a new day in dental, and to take five. With the thought in mind that we want dentists all across the state, as simple as I can say it. Just to help some and what you will have if you guide the patients. And I'm speaking about adults, more so because the pediatric population, as I said earlier, the zero to age 20s are working very well and it's the mainstay of the program. But if you thinking chairside here now, and if you look the patients in the eye. And talk to them about their expectations. You're gonna have some appreciative patients. But don't believe, as a dentist, we know our craft as dentist, don't believe as a dentist that the patient is going to know what they have, and they don't need some form of guidance. So, I'll say to a dentist that's thinking about it, take some patients that you are comfortable with.

[00:33:10] Paul Logan: On that note, I think talking about just what it means to those patients to have access to, especially patients where there, there may not be many Medicaid dentists or any Medicaid dentists currently taking new patients. I was wondering if each of you could you share a story about what the expansion to the adult benefit has meant for patients in Virginia?

[00:33:34] Justin Gist: Yeah, so I'll share a personal story, and I shared this when Dr. Hairston and I traveled up to Virginia Tech to present on a program. I work out at the gym five to six days a week. I'm a pretty avid gym goer. And at my last gym I met a guy that, that worked as one of the fitness instructor instructors at my gym. And he and I had a conversation one day and he told me that he moved here from California. He got his undergrad at Cal Berkeley and worked for Google for 10 years. He was laid off at Google and decided to move across country with his wife and two daughters to follow his dream of opening his own gym.

[00:34:13] Justin Gist: So, his wife was born and raised in Virginia, so they moved here. He worked part-time at the gym, and his entire family was on Medicaid, right? So, his family was able to utilize Medicaid for that health benefit while he worked to follow his dream of opening up a gym. So, I talk about the Medicaid profile all the time. So, we often think that a Medicaid member looks a certain way, but this can be so much further from the truth, right? So, they're your waiters as Starbucks, your cashiers at Wegmans. And that's one of the stories that, that's really always remained with me. 

[00:34:47] Paul Logan: Thank you Justin. Dr. Hairston, do you have something you'd like to share?

[00:34:49] Dr. Zachery Hairston: I think there should be a shift in how we view dental care. How we administer dental care. I'll go back to something Justin and I both have spoken about earlier. Oral health equals overall health, 

[00:35:06] Paul Logan: Right. 

[00:35:08] Dr. Zachery Hairston: And there has been a rise in tide for that mantra over the last three or four years, and it's on a national basis, but it's been there all the time.

[00:35:22] Dr. Zachery Hairston: Oral health has been a very significant part of overall health, but it was not seen in the way that it is now. So, there is so many different chronic medical conditions that are associated with keeping the teeth clean. The periodontia. That's behind the programs, up to three cleanings a year. That requires education to dentists as well as medical doctors, as well as any type of medical services across, and we are gonna keep saying it. Oral health equals overall health. We think, oftentimes of diabetes as being a problem, but dementia is a problem with oral health when it's not taken care of properly.

[00:36:23] Paul Logan: Thank you both so much for your time today in closing out. I know many VDA members fought hard in the successful effort to achieve longer overdue state investment and increasing funding for the program, increasing reimbursement rates in the last several years, many of the dentists listening to this conversation have been strong advocates for the program. You mentioned Dr. Cindy Southern, who's been there with you and Dr. Hairston, you as a VDA member yourself have been there, for the program. What's the best way that they can take a role in shaping the future of the dental Medicaid benefit in Virginia, ensure that it works for their patients and allows their practices to provide sustainable dental care. In communities of need. 

[00:37:08] Justin Gist: First, I just wanna say thank you, Paul. The advocacy and leadership from VDA members over the years have been truly instrumental in helping us grow and strengthen our Virginia Medicaid dental program. The increased reimbursement rates, we've secured the expansion of benefits and really the momentum we've built around access. None of that would be possible without the persistent informed and passionate voice of the VDA. Again, thank you. 

[00:37:35] Justin Gist: You asked about how can the VDA continue to shape the future? And I think there are a few ways. The first is really by education mentoring and being a voice of guidance.

[00:37:48] Justin Gist: So, there are many young dentists that are entering the workforce with a strong sense of purpose, but they may be unsure about how Medicaid really fits into their model. So, if you're a VDA member with experience. Help mentor and guide the next generation. Your perspective can really shift mindsets and inspire participation in areas where access is still a challenge.

[00:38:10] Justin Gist: The Medicaid of 15, 10, even five years isn't the same Medicaid of today. We've made policy changes that are provided-friendly with the goal of increasing access to care. I think the second thing is through advocacy. So, Medicaid is sustained through public will and policy choices. So, if you're a VDA member, continue sharing your stories with legislators, with local media and within your networks. Help others understand what you already know. That you can have profitable business model while helping the Medicaid community. So, Medicaid can really be an avenue of revenue within your office. So, I think that advocacy piece is very important.

[00:38:54] Justin Gist: The third I would say would be participating in workforce development and pipeline efforts. One of the biggest challenges is ensuring that we have enough dentists and the right distribution of providers across all the regions. When we talk as rural and underserved communities, especially. We've discussed in our program hosting externships or rotations with some of our providers focused on the Medicaid population with some offices. Really supporting efforts to recruit and retain Medicaid providers in areas with the greatest need.

[00:39:27] Justin Gist: And I think the last thing and possibly the most important thing is to participate in the program by seeing Medicaid members, right? So, the most impactful way to support the future of Medicaid care is to become or remain an active Medicaid provider. So even if you're not able to dedicate your entire schedule to Medicaid patients we spoke about this earlier, every appointment counts.

[00:39:52] Justin Gist: And then I'll say this, and this may be my fourth or fifth time saying this, but I mean it utilize myself and Dr. Hairston as a resource. So, we are here for you. We are a continual resource. I give out my cell number, my email address, however we can help, we are willing to do.

[00:40:08] Justin Gist: I mentioned it earlier we travel all around the state, meeting providers and provider offices. if you need us, we are one call and one road trip away. 

[00:40:19] Paul Logan: Justin, Dr. Hairston. Thank you so much for, as you just said, being available for our members, helping them better understand what's going on with the Medicaid program, what the latest developments are. But thank you again for being available for our members and for the work you're doing for this very important program for the Health of Virginia.

[00:40:39] Justin Gist: Thanks, Paul. 

[00:40:40] Dr. Zachery Hairston: Thanks to you Paul.

[00:40:41] Paul Logan: Once again, we will have additional information about the VDA Dental Medicaid benefits Liaison In the show notes, if you found this discussion valuable, please like, subscribe and share this podcast. Thank you for listening, and we look forward to having you return for the next episode of The Fulcrum a Virginia Dental Association Podcast.