Addressing dental and maternal health outcomes for Minnesota’s communities of color

Minnesota has significant disparities in several health measures, from asthma to cancer survival rates, dental health and maternal and infant mortality rates. The Blue Cross and Blue Shield of Minnesota Foundation hopes to improve outcomes in two areas: dental and birthing through grants to four organizations in the state.

The four $100,000 grants are a part of Blue Cross Blue Shield’s Equitable Care and Coverage program, which offers funds to nonprofits that focus on providing care for people eligible for public program coverage under Medical Assistance and MinnesotaCare. Blue Cross Blue Shield of Minnesota also funds MinnPost’s race and health equity beat but does not weigh in on editorial decisions.

What will the money go toward?

Three of the grantees focus on achieving birth equity, and one aims to improve dental access for those who experience barriers to dental services.

Gaps in dental care are heavily apparent across the nation. Between 2011 and 2016, 17% of children ages 2 to 5 from low-income households had untreated cavities in their primary teeth, which was three times the percentage of children from higher-income households, according to CDC data.

Apple Tree Dental has plans in the works to create an ecosystem for dental care and referrals, emphasizing its efforts on communities that are uninsured, underinsured or insured through Medicaid.

Many dentists don’t accept public insurance – making it harder for lower-income families to get care. In 2019, 40% of Minnesota’s roughly 3,000 dentists did not accept public insurance.

Apple Tree Dental has initiatives where it delivers dental care in senior housing and nursing facilities, schools, and its own outpatient clinics, and its programs take different approaches depending on the barriers those communities face, said Dr. Michael Helgeson, the CEO of Apple Tree Dental.

“The barriers are different if we’re in rural Minnesota; there are different sets of barriers. If we’re dealing with people with mental health and chemical dependency issues, they have barriers,” Helgeson said.

Reaching the uninsured

Apple Tree will use funding from this grant to address the barriers that affect low-income families and children in the Twin Cities metro, especially those who are uninsured.

“Many of them face concerns about their immigration status and things along those lines that prevent them from even seeking any type of coverage,” Helgeson said. “The disparities in dental diseases are often even more dramatic than they are for other types of healthcare. That’s a major problem for our society, and I think we need to get to the point where every single person is able to get the health education and the health services that they need.”

The organization will partner with Ready, Set, Smile, a nonprofit that provides dental services at 33 early childhood education centers and schools that enroll high percentages of low-income children whose families lack access to dental care and oral health education.

Ready, Set, Smile employs community health workers that are from the same ethnic groups as the patients and get trained to provide education about oral health to students and families.

Of the children they served last year, 96% were people of color, more than 50% were from immigrant families and 38% were uninsured, according to Dr. Adele Della Torre, the organization’s executive director.

Ready, Set, Smile can provide education and prevention services, like putting silver diamine fluoride on teeth to temporarily stop cavities. Children with dental problems, like painful or infected teeth or large cavities, may require a filling or extraction, which requires the resources of a dental office. Those children will then be able to get follow-up care at one of Apple Tree’s three clinical sites in the Twin Cities – or at other private practices that have agreed to take referrals for those without insurance and those without payment.

“Dental diseases among these children are dramatically higher than for their wealthier counterparts that are in other school settings,” Helgeson said.

Funding will also go towards Apple Tree Dental’s telehealth services so families can have their first visits virtually. Helgeson said by doing a phone or computer visit, both the clinic and the family can save time and resources.

“What that does is it avoids all the time and expense and hassle of, first of all, waiting to get an appointment and to come in physically. And then the cost of transportation, maybe having to get daycare, having to bring other kids along, to come in for a visit only to learn kind of that you’re going to need to come back for another visit to get the procedure that you need done,” Helgeson said.

Maternal and infant outcomes

The other three recipients of the Blue Cross Blue Shield grant focus on birth equity – improving infant and maternal outcomes for Black and Indigenous families.

From 2017-18, Black Minnesotans comprised 13% of the state’s birthing population but accounted for 23% of maternal deaths. Indigenous Minnesotans, who made up 2% of the birthing population, accounted for 8% of maternal deaths, according to the 2022 Maternal Mortality Report. 

Some funding will go to the Northwest Indian Community Development Center in Bemidji, which focuses on advancing infant and maternal outcomes among Indigenous families in northwest and north-central Minnesota, by connecting families with prenatal care, cultural teachings, breastfeeding resources and building a network for ongoing care for families with infants.

The African American Babies Coalition is another recipient of the grant. The coalition has focused on creating education around brain development and childhood education for Black and brown families since 2005.

“To have healthy children, we need healthy parenting and (healthy) mothers and babies,” said Sameerah Bilal-Roby, the founder and director of African American Babies Coalition in St. Paul.

The coalition works with various groups involved in African American communities to transfer knowledge about supporting brain development and healthy child development practices.

Roots Community Birth Center will use the funding to support culturally centered reproductive health services, mental health services, screenings and immunizations for families who experience poor health outcomes in Minneapolis, Brooklyn Park and Brooklyn Center. The funding will also allow the center to provide prenatal care for people regardless of their insurance type or ability to pay.

Blue Cross Blue Shield hopes to provide more than just funding by creating a partnership with recipient organizations.

“We don’t have unlimited resources, but we believe our resources can be impactful,” said Bukata Hayes, the vice president of racial and health equity at Blue Cross Blue Shield. “I think the partnership, the resources beyond the grant that we provide to our grantee partners, becomes really critical.”