Chair McLeod convened the Interim Healthcare Committee to review the background memorandum and stakeholder testimony assembled for the study directed by House Bill 1567, the panel’s year‑long review of unmet dental and oral health needs.

The memorandum, summarized by committee staff, lays out a 27‑point study charge including provider workforce assessment, Medicaid enrollment barriers, availability of complex dental services and review of reimbursement and volunteer programs. Witnesses from Health and Human Services, the state oral health program, dental education programs, FQHCs, mobile clinics and tribal advocates described persistent access gaps and possible fixes.

Why it matters: Witnesses said access gaps are causing avoidable pain, emergency‑department visits and long wait times for children and people with disabilities. Testimony tied problems to uneven Medicaid participation by providers, low hospital reimbursement for dental surgery, rural workforce shortages and structural barriers in tribal health systems — and offered concrete programmatic work already in place that could be scaled.

Medicaid coverage and claims processing
Krista Fremming, Assistant Director of the Medical Services Division at the Department of Human Services, presented Medicaid enrollment and dental benefits data. North Dakota enrolls roughly 107,000 members at a time and covers a range of dental services for eligible groups, she said, but adult Medicaid expansion beneficiaries “do not get the services that are listed on slide 6.” Fremming highlighted increasing dental expenditures — up about 60 percent between 2020 and 2025 — and told the committee the department has stood up a provider education team to help dental offices with enrollment and billing after several high‑profile auditing and clearing‑house disruptions.

State oral health programs and school‑based prevention
Sherry Kiefer, director of the state oral health program, described two federal grants (CDC and HRSA) that fund school‑based sealant programs (CLND), medical‑dental integration pilots, workforce pipeline work and case management for referrals. The CLND program served 69 schools in the 2024–25 school year; Kiefer reported 2,636 student screenings and thousands of fluoride varnish and sealant applications. “Our school based sealant program known as CLND has been in place since 2012,” she told members.

Workforce and education pipeline
Bismarck State College’s dental programs were a recurring theme. Mary Volk described the QDA (qualified dental assistant) program (30 students; largely online plus 300 chairside hours) and a pending Commission on Dental Accreditation site visit for a dental‑hygiene associate degree program. Witnesses urged expanding “grow‑your‑own” training, fourth‑year dental student rotations at FQHCs and strengthening loan‑repayment incentives to recruit dentists into rural and tribal communities.

Hospital capacity and pediatric surgical care
Pediatric dentists described a narrow supply of hospital operating‑room access for dental rehabilitation under general anesthesia. “The wait list in Bismarck is about 5 months with 300 and some kids on their waiting list,” said Dr. Tague Brickhouse of Mystic Smiles, noting similar delays in Minot and Fargo and that ambulatory surgery center/hospital reimbursement for dental rehabilitation lags comparable procedures. Providers said low hospital facility payments and limited block time constrain the system’s ability to treat very young children or special‑needs patients requiring OR care.

Mobile clinics, FQHCs and community programs
Speakers emphasized the role of mobile units and community dental clinics: Brent Kleinian (Ronald McDonald House) described a Care Mobile that serves about 40 sites annually across western North Dakota, reporting that roughly 37 percent of children seen were on Medicaid and about 60 percent uninsured. FQHC leaders described mobile units, urgent dental clinics (Ray), and student rotations that both expand access and expose trainees to rural practice.

Tribal communities and structural barriers
Anthony Bauer (Deputy Director, Indian Affairs) emphasized the scale of disparities in tribal communities — “we don't even have 1 dentist for every tribe” — and described additional logistical and infrastructure barriers, including housing, water quality, long travel distances and IHS purchasing rules that complicate access and workforce recruitment.

Policy options raised
Witnesses proposed a mix of near‑term and structural responses: expand school‑based prevention and mobile clinics, raise or realign hospital/ASC reimbursement for dental rehabilitations, increase loan‑repayment and retention incentives tied to service in high‑need areas, support dental student rotations at rural clinics, and explore mid‑level provider models where appropriate. Several presenters urged that expansion of Medicaid dental benefits for adults in the Medicaid expansion group remain on the table as a high‑impact policy lever.

Quotes from testimony
• Krista Fremming: “Medicaid expansion adults do not get the services that are listed on slide 6.”
• Dr. Tague Brickhouse: “The wait list in Bismarck is about 5 months with 300 and some kids on their waiting list.”
• Brent Kleinian: “We serve 40 or 41 sites a year.”
• Anthony Bauer: “We don't even have 1 dentist for every tribe.”
• William Sherwin (N.D. Dental Association): “Provider enrollment does not mean provider participation.”

Next steps
Committee members asked the department and program leads to return with more granular data (for example: follow‑up rates on school referrals, outcome measures from outreach programs, and the feasibility and costs of expanded OR capacity). Staff agreed to collect requested materials, and the committee indicated it will reconvene to continue the HB1567 study and to hear follow‑up briefings from Medicaid staff, the oral health program and education partners.

Ending note
The testimony assembled a wide set of operational details and suggestions that the committee framed as inputs for legislative and administrative options to reduce wait times, expand preventive services and strengthen the dental workforce in North Dakota.