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State Spotlight: Building on Solid Foundation, Iowa Jumps Into Top 5

Thanks to efforts of the Iowa Department of Public Health, Iowa has made huge strides since the last A State of Decay report.

In Northwestern Iowa just three counties south of the Minnesota line, Pocahontas County’s population has dropped and dropped and dropped since boasting 15,000 pioneer descendants during the first half of the 20th century. Today, fewer than 7,000 people remain, and like much of Iowa, a disproportionate number are in the 65+ age group.

Thanks to efforts of the Iowa Department of Public Health, the growing population of at-risk older adults in Pocahontas and five adjacent counties have improving prospects for receiving oral health services. As reflected in the state rankings, such efforts have helped Iowa make huge strides since publication of A State of Decay, Vol. III, propelling the state from number 23 in the last volume to number 3 for 2018.

To address the needs of the 16% of its residents who are 65 years or older, Iowa has added a State Oral Health Plan with SMART objectives for older adults and completed a statewide older adult Basic Screening Survey. The state also has maintained its support for all 13 common dental benefits for Medicaid beneficiaries aged 65+ and has expanded its I-Smile Silver pilot program.

“Our success with our I-Smile program for children is what really gave us the platform for expanding into I-Smile Silver,” said Bob Russell, DDS, MPH, Public Health Dental Director and Chief of Oral & Health Delivery Systems for the Iowa Department of Public Health.

With dental hygienists as the “boots on the ground” in the area, the I-Smile Silver program helps older adults find providers, afford care, get transportation to dental appointments, and overcome barriers related to medical problems or mobility.

I-Smile Silver has thus far been a remarkable success because of the cooperation and teamwork among nearly two dozen stakeholders that provide funding and support through the Lifelong Smiles Coalition, Russell explained. The 11-year experience with Iowa Medicaid and the I-Smile program for children was an especially important factor, as were funding sources through the Delta Dental of Iowa Foundation and grants from the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

Lifelong Smiles Coalition grantees receiving a check from Delta Dental of Iowa Foundation

Yet Russell knows, given the oscillations that can occur in public programs, I-Smile Silver could disappear in any number of ways, including moving dental services into Iowa Medicaid’s managed care program. “The next phase of this effort is to find ways for the program to be sustainable,” he said.

Regardless of future challenges, Iowa is setting the stage to remain in the upper echelons in future state rankings in A State of Decay. Budgetary issues are just as problematic in Iowa as in nearly every other state, but Russell will be ready to deploy new data available through the I-Smile Silver performance system now in development.

“We’ve been fortunate to have the right mix of staff, relationships, and funding to be able to expand into oral health services for older adults,” Russell said. “I look forward to the day when we can take this program to all 99 counties and make it a sustainable part of care for our vulnerable seniors.”


I-Smile Silver newsletter, October 2016. Retrieved from:

Lifelong Smiles Coalition. Retrieved from: http://www.lifelongsmilescoalition.com/partners.php

The Wisdom Tooth Project is a program of Oral Health America