Dental fellowship serves special needs patients 

With cuts to Medicaid on the horizon, the strain on New York’s dental care system could be high, particularly for patients with intellectual and developmental disabilities.

In New York’s 25th Congressional District, which includes all of Monroe County and parts of Ontario County, roughly 205,000 people are enrolled in Medicaid. Under the One Big Beautiful Bill Act, an estimated 35,475 individuals would be newly uninsured, with 5,067 losing coverage under the Essential Plan.

Patients with intellectual and developmental disabilities such as Down syndrome, cerebral palsy, and autism are often reliant on Medicaid, and will likely face more challenges in accessing dental care, which is already difficult for those populations.

“We’ve seen patients that have been waiting a year and a half to almost two years to get to treatment,” says Jonathan Teyan, president and CEO of New York State Academic Dental Centers. “That is not a humane way of delivering care.”

NYSDAC’s Fellowship to Address Oral Health Disparities is a program that helps provide dental care to patients with intellectual and developmental disabilities. It was started in 2018 to address a gap in coverage for the intellectually and developmentally disabled. Through the program, postgraduate dental students work with these patients while earning a steady income and gaining opportunities for employment after completing their fellowship.

“(The fellowship) benefits New York, because we get more community providers. And then it also benefits recent dental grads, because they receive an additional year of training and their salary is covered,” Teyan says. “And when they’re out in their own practices, that means they can accept more difficult cases in a community setting and not have to refer them to a dental school clinic.”

Candidates for the program must be eligible for licensure in New York or hold a current license. Graduates who have completed at least one year of postdoctoral training are typical candidates. However, Teyan says the organization is happy to accept already practicing dentists who want to do more to help patients with intellectual and developmental disabilities. 

Participants are placed at a dental center inclusive of the six schools NYSADC covers. This includes Columbia University College of Dental Medicine, the Eastman Institute for Oral Health at the University of Rochester School of Medicine and Dentistry, the New York University College of Dentistry, the Stony Brook University School of Dental Medicine, the Touro College of Dental Medicine at the New York Medical College, and the University at Buffalo School of Dental Medicine. They also dedicate 20 percent of their time to teaching or research at their school.

Fellows are guaranteed a salary level for a second-year medical resident for their fellowship year and may be eligible for federal or state loan-repayment programs upon completion. Candidates must also commit to a year in New York at a practice with a significant number of special needs patients. 

Patients with intellectual and developmental disabilities have a wide spectrum of needs, but most commonly, they require a greater amount of time, equipment, and staff for appointments. Some patients may need multiple visits to receive care.

These accommodations clash with practices that are trying to optimize schedules, Teyan says. In addition, reimbursement rates from Medicaid are low, meaning that patients who rely on it are less likely to be accepted at all dental practices. The effect of federal cuts to Medicaid are unknown at this time, but likely will not improve matters.

“We’ve actually been making the case to the governor’s office, (state) Department of Health, and the Legislature over the past couple years that we need the Medicaid reimbursement for oral health to increase, particularly for this patient population,” Teyan says.

“It may seem counterintuitive as we’re staring down the barrel of federal cuts, but right now, with our safety net providers, they are on average losing $150 per Medicaid patient visit,” he adds. “And when as many as 75 percent of patients are using Medicaid, that’s not a sustainable business model.”

These issues, when combined, mean that smaller dental practices are less willing to take on those types of patients, which forces them to go much further to find care.

“Dental school clinics have really become one of the main safety net providers for this patient population. Many of them can’t find providers in their communities, so they have to go to the academic dental centers,” Teyan says. “That’s part of the dental schools’ mission, so it’s not like there’s an issue there, but what it does mean is that people have to travel, sometimes long distances, to get to those clinics.”

Teyan notes that the catchment area for the Eastman Institute of Dentistry extends as far as Watertown, with some patients regularly making long drives (three hours or more).

Additionally, the high cost of dental school exacerbates this issue. According to the American Dental Association, the average cost of a four-year dental degree ranges from $227,693 for residents at a public school to $396,303 at a private institution.

Many students have a passion when it comes to working with intellectually and developmentally disabled patients, Teyan says. Still, the cost of an education means they simply cannot afford to take a lower-paying job, such as one with fewer patients overall but more with special needs.

The fellowship is designed to aid students in that respect. Fellows’ salaries are covered during residency, while they work alongside dental professionals and establish connections for future job opportunities. Fellows also complete the Commission on Dental Accreditation’s requirement for clinical training with special health care needs, a measure added in 2020, through the program.

So far, the fellowship has three graduates. All have continued to work with patients with complex care needs, with one, Alex Dorrough, also teaching as special needs adjunct faculty at his alma mater, the Touro College of Dental Medicine in Westchester.

No students from UR have participated in the fellowship so far. Teyan says greater recruitment efforts must be made for the program and dental care in general. Even so, there is reason to be hopeful as well. The fellowship is now fully funded by the state, says Teyan. In the past, private foundations funded it.

“It shows that we know providing care for our I/DD community is a need,” he says. “There are a lot of people who are passionate about providing care, and we just need to give them the chance to follow through with that.”

Interested parties can apply to the NYSADC Fellowship to Address Oral Health Disparities online on a rolling basis with flexible start times.

Jacob Schermerhorn is a Rochester Beacon contributing writer and data journalist.

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