Clinics on wheels bring doctors and dentists to the deserts of health care

Nearly 12 years ago, a nonprofit organization focused on substance abuse prevention in Lyon County, Nevada, expanded its services into dental care.

Leaders of the Healthy Communities Coalition sprang into action after two of their food pantry volunteers used tweezers to pull out abscessed teeth. The volunteers saw no other option to ease their overwhelming pain in the small town where they lived, 40 miles southeast of Reno, due to a shortage of dental care providers.

That drastic act, said Wendy Madson, executive director of the coalition, prompted her organization to use mobile clinics to offer health and dental services in rural communities where there are not enough patients to maintain physical offices.

The coalition now sends a van equipped with dental equipment to schools in the county to treat hundreds of students per stop several times a year. They also host events that provide free care for adults in the region. The response has been overwhelming.

“Dental is the hot ticket,” Madson said. “Everybody wants dental. The availability of those services is what sells out first at those big mobile events.”

The coalition’s mobile programs reflect efforts nationwide to deliver services to patients experiencing gaps in the health care system, especially in rural areas.

Rural residents face a more significant shortage of health care providers, including dentists, compared to their counterparts in larger cities. Since the start of the pandemic, mobile clinics have increased access to a variety of services in hard-to-reach locations with sparse populations.

A recently passed law making it easier for rural communities to pay for new mobile clinics could expand this trend. In the past, clinics serving low-income rural residents couldn’t spend federal grant money, called new hotspot grants, on mobile services in communities where they didn’t already have facilities.

Then last fall, Congress passed the MOBILE Health Care Actsponsored by Sens. Jacky Rosen, D-Nev., and Susan Collins, R-Maine, which gives federally qualified health centers (health clinics that serve medically underserved areas) greater flexibility to use federal funds to create and operate mobile units.

Since 2019, the number of roadside mobile clinics has expanded, according to the National Association of Community Health Centers. Many were used for COVID-19 testing and vaccinations. And health and community organizations began using mobile units to provide primary care, behavioral health and reproductive services to remote patients. The new funding avenue could soon put even more mobile health vans on the road.

For now, the law depends on funding from Congress, and experts predict it could be at least a year before health centers can access the grant money.

Freed from brick-and-mortar requirements, healthcare facilities can deploy the vans

Once funded, the regulatory change will allow health centers to collaborate with independent organizations like the Nevada Coalition of Madson Health Communities to expand services in underserved regions. Because the coalition is not a federally qualified health center, it has relied on a combination of other federal and state grants.

Nearly 1,400 federally qualified health centers across the country receive federal funds to provide comprehensive health services in underserved areas. The previous requirement that health centers establish brick-and-mortar clinics before expanding mobile clinics prevented many from applying, said Steve Messinger, policy director for the Nevada Primary Care Association. It was burdensome and expensive for health centers.

But in rural areas with small populations, well-served by mobile clinics, it wouldn’t make sense to first set up a building with a full-time provider, he said. That could eat into the budget of a federally qualified health center.

As health center advocates lobby Congress for basic funding, the Healthy Communities Coalition is forging ahead with three dental events this year funded by a grant from the Health Resources and Services Administration, part of the Department of Health and Services. Humans.

At the first medical outreach event the coalition hosted in 2012 in Lyon County, where 61,400 residents spread over more than 2,000 square miles, more than 200 people showed up for free care and 150 teeth were extracted, Madson said. Since then, the organization has hosted several events a year, except for 2020, when the pandemic halted work.

Many of the dental events are school-focused and provide children with services such as exams, x-rays, sealing, varnish, and cleanings. But there’s also an overwhelming need for care among area adults, Madson said, because Medicare and Nevada Medicaid don’t include comprehensive dental coverage for adults. It’s harder to finance those events, he said.

Of Lyon County’s five communities, at least one, Silver Springs, does not have a single dentist. There are 10 total dentists in Fernley and Dayton, communities with a combined population of 38,600, but only two of those practices accept Medicaid, which covers low-income people under 21 and limited dental services for adults.

Meeting a desperate need for health and dental services

Traci Rothman, who runs the coalition’s food pantries, said the dental outreach events made a difference for her 29-year-old son, who moved to Silver Springs last year. He went to two mobile clinics for free care, which Rothman said was a huge relief because he is uninsured and in dire need of dental care.

“Otherwise, you go to someone you’re paying cash to,” he said. “Often I can’t afford it, honestly, it’s just out of reach for some people, or most people…in rural areas.”

Madson said the coalition stepped in to help a young student in desperate need of a root canal. The coalition is helping the girl’s family apply for Medicaid or Nevada Check Up, the state’s Children’s Health Insurance Program, and is paying $1,600 to cover the service with federal grant money. Another student had to be referred to several specialists before she had her decayed baby teeth surgically removed and received restorative treatment for permanent teeth that had begun to decay.

“Her mom was so thankful she was in tears,” Madson said. “She told me that her daughter woke up without instant pain for the first time in years.”

Madson said her organization has enough grant funds for three events through May, but she hopes the MOBILE Healthcare Act will help expand services. In addition to dental care, the group offers primary care mobile clinics for immigrant workers in Yerington, a small town in agricultural region about 70 miles southeast of Reno.

Sara Rich, executive director of Choptank Community Health in Maryland, said she shares Madson’s hope.

Choptank serves five Maryland counties, including small towns between the Chesapeake Bay and the Delmarva Peninsula. In the midst of the pandemic, the health organization formed an unlikely partnership with a car dealer and used federal COVID relief money to purchase a Ford Transit cargo van for mobile clinics.

Choptank used his new van to provide vaccinations, but has since started using it to provide primary care to immigrant workers and dental services to children at 36 schools. The mobile clinics have been so successful that the health center is working on purchasing more vans to expand its services.

Rich said mobile clinics are “breaking down barriers that many of us have been working on for a long time.”

Among the new services Choptank is looking to provide are behavioral health, substance use disorder prevention and treatment, and skin exams for people who work on Maryland’s shores.

“Flexibility has been a theme in recent years,” Rich said. “I think this MOBILE Health Care Act will help us do that even more in the future.”

KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs in KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.