Very-low-income people with disabilities can get health coverage through Texas Medicaid. Children, adults in institutions, and a small percentage of adults in the community have a dental benefit. Many people react in disbelief when learning that most adults with disabilities in Medicaid community care do not have access to a dentist. This leads to very bad outcomes, like resorting to an emergency room when in severe dental pain. The treatment there is not dental, only antibiotics and painkillers, often opioids. Some people are in such bad shape they must be hospitalized, and a few actually die from complications. What caused this? Simply, untreated cavities, a treatment that is usually done in a dental clinic. That’s not all. Poor oral health leads to elevated heart disease, diabetes, hypertension, stroke, cancer and more. These facts make a strong argument for adding a dental benefit.
​
Texas leadership believe in limited government and low services. Texas ranks 49th in community services for people with disabilities[1] and remains among the minority of states not adopting Medicaid Expansion. To succeed, we would need a collective effort. CTD is well positioned in the Capitol and would serve as advocacy lead, including bringing self-advocates, individuals with disabilities. We would need to make the business case, that requires a skilled health research organization. Texas Health Institute filled that role. Influential legislative champions had to be recruited and supported. Our top champions are Senator Lois Kolkhorst and Representative Joe Deshotel. And we needed to show broad support from other groups. That meant putting together a strong list of supporting organizations. Among those would be some obvious groups like the Texas Oral Health Coalition and the Texas Dental Association, but we went beyond and added major trade associations for doctors, hospitals, nurses, health plans and dozens of disability organizations.

It took time. In 2017, we secured a study of the issue. In 2019, we passed a bill to pilot comprehensive dental care. In 2021, after the language passed through five bills, on the last day, a preventive dental benefit was passed. This was the result of many hearings, legislative visits, and organizing. It’s not over as we will continue to monitor the rollout. Yet, the impact is huge. Around 450,000 adults with disabilities, who would have had no dental visits in their adulthood, will now be able to see a dentist every year. The smiles will look very nice indeed.


[1] United Cerebral Palsy and ANCOR Foundation, The Case For Inclusion Report 2019

The coronavirus pandemic of 2020-2021 has had a profound impact on the mental health and well-being of Texans, as well as the rest of the US. The pandemic highlighted the need to revitalize the infrastructure of our public health system and to protect it from political influence at all levels. The trauma inflicted by the pandemic has touched all of us. Many have lost family members or friends. Other stresses include loss of employment, insurance coverage, housing, and access to healthcare. Children have lost more than a year of seeing their classmates and friends in person and have had to learn how to learn through a virtual school environment. Many small business owners lost their sole source of income due to restrictions required to minimize the spread of the virus.
 
The CDC reports that as a result of all of this, there has been a 27% increase in symptoms of anxiety and depression between April 2020 and February 2021. Emergency room visits due to overdoses and suicide attempts were up 36% and 26%, respectively. More than 87,000 Americans died of drug overdoses in the year ending in September 2020, representing a profound increase. Behavioral health service providers reported increased demand at the same time that they were decreasing staff sizes and closing clinics. Although the use of telehealth has risen dramatically, the effect on providing care for those with behavioral health and substance use disorders (SUD) has yet to be determined. The impact of the pandemic has disproportionately affected our communities of color. It has highlighted how a system that prioritizes a law enforcement and criminal justice approach to psychiatric crises often results in unnecessary injuries and deaths.
 
The health care community has responded rapidly to the new environment created by the pandemic. Some best practices have emerged:

• Increased access to behavioral health and SUD providers via telehealth
• Integration of behavioral health into primary care practices
• Integration of evidence-based treatment of SUD into behavioral health and primary care practices (medication-assisted therapy or MAT)
• Use of mobile applications to support healthier behaviors and activities including use of rewards when individuals are behaving in ways that support improvement in mental health symptoms and maintenance of recovery (contingency management)

 
There has also been a significant increase in enrollment in Medicaid and the Healthcare Exchange during the pandemic leading to many gaining or regaining access to health care.
 
As the public health institute of Texas, Texas Health Institute (THI) is committed to helping Texas overcome the trauma from the pandemic through their continued devotion to advancing the health of all Texans and their communities. THI’s dedicated staff continues to produce outstanding research and translational activities such as the recent work on health equity through the HOPE Initiative that is featured by the New England Journal of Medicine. THI works with the Texas Primary Care Consortium to integrate behavioral health into primary care practices throughout Texas. THI has been a leader in advancing collaborative action on chronic pain, SUD, obesity, oral health, genetic disorders and other topics important to Texans. To quote THI, “We strive to advance the health of all.”

April is National Minority Health Month, and this year’s theme sponsored by the HHS Office of Minority Health is #VaccineReady, underscoring the importance and urgency of vaccinating racial and ethnic minorities disproportionately impacted by COVID-19.

As seen across the nation and Texas, Black, Hispanic, and Indigenous populations have faced the brunt of cases, severe illness, death, and economic loss from the pandemic, yet they continue to have lower rates of receiving the COVID-19 vaccine. Local data shed further light into these realities. For example, a new report from the COVID-19 Modeling Consortium finds that areas across Austin with higher social vulnerability and rates of infection, such as the Eastern Crescent, have lower rates of vaccination. Similar gaps in vaccination rates by race and place have also been reported across Harris County, Dallas area, and other parts of the state.

Upending these inequities will require centering equity in the COVID-19 vaccine rollout. What that means is working to ensure the vaccine is accessible to all people—especially to those most at-risk, and not just to those with means to navigate the system. As the supply and availability of vaccines continues to increase, the objective is to work quickly, safely, and effectively to get as many shots in arms as possible, and to take explicit measures to simultaneously reach at-risk low-income and communities of color to minimize preventable infections, severe illness, and death. Doing so will require working authentically with communities and their trusted leaders and partners to learn their concerns, provide accurate and credible information, and access to the vaccination.

Lessons, promising strategies, and guidance are emerging on how to more equitably rollout the vaccine. Kaiser Family Foundation released a summary of promising state-level actions for addressing racial equity in COVID-19 vaccine efforts, and Johns Hopkins produced detailed guidance for working with communities of color to ensure equity in COVID-19 vaccination. Leading public health experts Dr. Faith Fletcher and Dr. Aletha Maybank recently penned 5 Ways to Make the Vaccine Rollout More Equitable, and Dr. Kingsley Okafor with Kaiser Permanente highlighted steps for getting to vaccine equity by addressing health equity. Our own work in the wake of the H1N1 pandemic 10 years ago with the HHS Office of Minority Health provides important guidance and steps on engaging communities of color in public health crises, also offering equity lessons from the H1N1 vaccination and response efforts.

Taken together, the following are highlights of what we have learned and what is emerging as strategies for ensuring all communities and people across Texas have access to information, resources, and the COVID-19 vaccine to be #VaccineReady.