S4169

An Act implementing the Mom Project oral health program in the Department of Health and making an appropriation.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. As used in this act:

"Community oral health center" or "center" means the following in-State entities: a federally qualified health center, a dental home, or an acute care hospital licensed by the Department of Health that provides dental services to individuals who reside in a medically underserved area.

"Dental home" means a licensed dental practice that administers services in a manner that is accessible, culturally-sensitive, and family-centered. A "dental home" shall not include a licensed dental practice if less than 75 percent of the dental practice's patients are individuals who are low income and who reside in a medically underserved area.

"Department" means the Department of Health.

"Eligible mother" or "mother" means a State resident who is pregnant, low-income, and insured under the Medicaid or NJ FamilyCare program, or not enrolled in, eligible for, or determined presumptively eligible for coverage under any Medicaid program.

"Low-income" means a gross annual household income that is less than 300 percent of the federal poverty level.

“Maternal Health Organization” means the NJ Maternal and Infant Health Innovation Authority and the three New Jersey Maternal Consortia licensed as central service facilities by the department prior to the effective date of this act.

"Medically underserved area" means an area designated by the federal Health Resources and Services Administration as having too few primary care providers, a high rate of infant mortality and poverty, and a disproportionately high share of elderly persons in the population of the area.

"Mom Project" or "program" means the Mom Project program established pursuant to section 3 of this act.

2. The Legislature finds and declares:

a. Maternal periodontal disease is linked to preterm birth and low birthweight.

b. Pregnant women with chronic periodontal disease are seven times more likely to go into labor prematurely.

c. Treatment of periodontal disease during pregnancy has been shown to be safe and effective.

d. The federal Centers for Disease Control and Prevention reports that 47 percent of American adults 30 years of age or older have periodontal disease, and between 60 percent and 75 percent of pregnant women have gingivitis, which can occur due to hormonal changes during pregnancy.

e. Maternal periodontitis, which occurs with advanced untreated gingivitis, has been clinically and scientifically linked to preterm birth, pre-eclempsia, and low birth weight babies, although treatment during pregnancy has been deemed to be safe, effective, and recommended.

f. Access to preventive dental care during pregnancy reduced the occurrence of periodontal disease, and thus the need for neonatal intensive care unit (NICU) stays. Newborns with elevated oral bacteria are twice as likely to be admitted to the NICU and three times more likely to stay longer than seven days.

g. According to the American Academy of Pediatric Dentistry, early childhood cavities remain a significant, but preventable public health problem.

h. High levels of cariogenic bacteria in pregnant women can increase the risk of dental cavities in infants or young children.

i. Pregnant women and caregivers can implement preventive measures to decrease a child's risk of developing dental disease.

j. According to articles published in the New England Journal of Medicine and the Journal of the American Dental Association:

(1) the cost of dental care in the U.S. has increased 30 percent in the past 20 years;

(2) in 2023, the national spending for dental care was $174 billion, with $68 billion in out-of-pocket expenses;

(3) NICU stays add up to a significant taxpayers’ expense of over $5.5 billion annually;

(4) dental and oral disease is particularly burdensome to marginalized and chronically underserved populations; and

(5) Black and African American mothers and their infants in New Jersey are disproportionately affected by poor birthing outcomes and maternal morbidity, as well as by inequities in access to oral health care. According to the federal Centers for Disease Control and Prevention, Black women are three times more likely to die from pregnancy-related complications than white women. New Jersey has the highest such disparity, where Black women are nearly seven times more affected.

k. Pregnant women, women who have recently given birth in medically underserved areas, and people who earn a low-income tend to lack access to dental care due to:

(1) lack of insurance coverage for dental care services;

(2) the absence or shortage of free or reduced-cost dental care services;

(3) language barriers; and

(4) fear due to immigration status, discrimination, or bias related to racial or socio-economic status.

l. It is in the public interest for the Legislature:

(1) to fund the Mom Project as a sustainable model for access to oral health education and dental care for certain at-risk women who are pregnant or who recently have given birth; and

(2) to collect data regarding the effect of dental health care and oral health education on improving pregnancy outcomes.

3. There is established in the Department of Health, the Mom Project program.

a. The department shall administer the program in conjunction with at least one Maternal Health Organization. Within 90 days following the effective date of this act, the following services shall be provided:

(1) Each Maternal Health Organization shall implement an outreach plan to identify eligible mothers, who reside in the area served by the organization, and register the mothers in the program. Upon registration and in a manner that is consistent with federal and State privacy laws, the Maternal Health Organization shall endeavor to collect the following information from eligible mothers: whether the mother has or had access to a dental home during a current or prior pregnancy; the mother's oral hygiene routine, including the use of fluoride toothpaste; the mother's dietary habits; and the results of previous pregnancies.

(2) Each Maternal Health Organization shall be provided a comprehensive oral health education program with a proven record of implementation success, on a quarterly basis. Prior to the commencement of the oral health education program, each Maternal Health Organization shall require eligible mothers to complete a pre-education assessment that includes testing the mother's understanding of oral health and oral hygiene.

(3) The department shall select a trusted organization with an established perinatal oral health education program that holds a proven record of success, to conduct “Train the Trainers” quarterly sessions with each Maternal Health Organization, including recommendations for impactful community-tailored education, promoting medical-dental integration, and long-term impact.

(4) Each Maternal Health Organization shall provide eligible mothers a minimum of three hours of oral health education that includes the following: oral hygiene routines for mothers, infants, and children; nutritional counseling; education regarding the correlation between cariogenic disease and cardiovascular disease, diabetes, and gastric changes; the impact of tobacco, drugs, and alcohol on a mother's oral health and the unborn child; recommendations and resources for routine oral health care for mothers, infants, and children; and education regarding available educational support.

(5) Oral health education program trainers shall be compatible with the language and cultural needs of the eligible mothers enrolled in the oral health education program.

(6) Following the eligible mother's completion of the oral health education program, the Maternal Health Organization shall require the eligible mothers to complete a post-education assessment that includes testing to assess the mother's understanding of oral health and oral hygiene routines.

b. Within 90 days following the effective date of this act, a community oral health center seeking to participate in the Mom Project shall file an application with the department, in a manner to be determined by the department. The department shall require an eligible community oral health center to enter into an agreement with a Maternal Health Organization to implement the following:

(1) Following an eligible mother's completion of the oral health education program, the center shall develop a customized oral health treatment plan and nutritional recommendations for the mother, infant, and child, as applicable.

(2) Following an eligible mother's completion of the oral health education program, the center shall provide the mother, infant, and child, as applicable, oral health treatment for one year. The dental care shall include the following:

(a) a dental visit for a comprehensive exam, cleaning, caries risk assessment, periodontal charting, and the establishment of a one-year treatment plan;

(b) comprehensive dental care and restorative treatment as needed;

(c) a cleaning and treatment plan review approximately six months and one year following the date of the initial dental visit;

(d) two dental visits for the child of the mother; and

(e) identification of a dental home for the mother’s child before the child receives his or her first tooth.

c. Within 180 days following the effective date of this act, each Maternal Health Organization and community oral health center shall compile and report relevant data to the department, as determined by the department.

d. (1) Within 180 days following the effective date of this act, the department shall contract with a third-party to assist with data analysis and project evaluation activities.

(2) Prior to the expiration of this act, the department and the third-party hired to assist with data analysis and project evaluation activities shall informally convene an advisory panel of interested stakeholders, including, but not limited to, the Maternal Health Organizations and centers participating in the Mom Project, Medicaid managed care organizations, and the Department of Human Services to evaluate reported data.

(3) The evaluation shall consider, at a minimum, the costs of the Mom Project and comparison costs if similar services were purchased through the Medicaid program on a fee for service basis, the results of the oral health education program based on test results, and maternal and child health outcomes as compared to a similar group of Medicaid beneficiaries who did not participate in the Mom Project. Based on its findings, the advisory panel shall design a model to be potentially included in the Medicaid program.

(4) The department shall prepare and submit a report of its findings to the Governor, and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1) following the expiration of this act.

4. There is appropriated from the General Fund to the Department of Health such sums as may be necessary to effectuate the purposes of this act, but not to exceed $3,000,000, as shall be determined by the Commissioner of Health, as follows;

a. the organization that holds “Train the Trainers” quarterly sessions with the Maternal Health Organizations, shall receive the following reimbursement for services: $75,000 per Maternal Health Organization in the first year, $75,000 per Maternal Health Organization in the second year, and $75,000 per Maternal Health Organization in the third year;

b. each Maternal Health Organization shall receive the following reimbursement for services: $100,000 in the first year, $100,000 in the second year, and $100,000 in the third year;

c. community oral health centers shall receive the following reimbursement for services: up to $2,500 per eligible mother, and not to exceed 100 mothers in the first year, not to exceed 100 mothers in the second year, and not to exceed 100 mothers in the third year; and

d. the third-party hired by the department to assist with data analysis and project evaluation activities shall receive $150,000 for the provision of services.

5. This act shall take effect 90 days following the date of enactment and shall expire three years thereafter.

STATEMENT

This bill implements the Mom Project oral health program in the Department of Health (department) and appropriates $3,000,000 as provided in the bill.

Under the bill, the department is to administer the program in conjunction with at least one Maternal Health Organization. Within 90 days following the bill’s effective date, the following services are to be provided:

(1) Each Maternal Health Organization is to implement an outreach plan to identify eligible mothers, who reside in the area served by the organization, and register the mothers in the program.

(2) Each Maternal Health Organization is to be provided a comprehensive oral health education program with a proven record of implementation success, on a quarterly basis.

(3) The department is to select a trusted organization with an established perinatal oral health education program that holds a proven record of success, to conduct “Train the Trainers” quarterly sessions with each Maternal Health Organization, including recommendations for impactful community-tailored education, promoting medical-dental integration, and long-term impact.

(4) Each Maternal Health Organization is to provide eligible mothers a minimum of three hours of oral health education.

(5) Oral health education program trainers are to be compatible with the language and cultural needs of the eligible mothers enrolled in the oral health education program.

(6) Following the eligible mother's completion of the oral health education program, the Maternal Health Organization is to require the eligible mothers to complete a post-education assessment that includes testing to assess the mother's understanding of oral health and oral hygiene routines.

Within 90 days following the effective date of this act, a community oral health center seeking to participate in the Mom Project is to file an application with the department, in a manner to be determined by the department. The department is to require an eligible community oral health center to enter into an agreement with a Maternal Health Organization to implement the following:

(1) Following an eligible mother's completion of the oral health education program, the center is to develop a customized oral health treatment plan and nutritional recommendations for the mother, infant, and child, as applicable.

(2) Following an eligible mother's completion of the oral health education program, the center is to provide the mother, infant, and child, as applicable, oral health treatment for one year.

Within 180 days following the bill’s effective date, each Maternal Health Organization and community oral health center is to compile and report relevant data to the department, as determined by the department, and the department is to contract with a third-party to assist with data analysis and project evaluation activities. The department is to prepare and submit a report of its findings to the Governor and Legislature.