Dental program for low-income kids could lose 55% of funding
A longstanding Metro Health program providing dental care to children from low-income families in San Antonio is facing a steep funding cliff. Officials worry that the city will see increased rates of tooth decay if the funding gap can’t be bridged.
The city health department’s Oral Health Program will lose around 55% of its funding in September when $1.4 million authorized under a federal Medicaid 1115 waiver expires. The federal Medicaid waiver allows states to test new health coverage strategies.
The $2.5 million Oral Health Program brings dentists to Title I schools in San Antonio, providing free oral health exams, decay treatment and prevention, oral hygiene education, case management for children with severe decay, and connects families with longer-term dental care. It served 17,000 kids in San Antonio last year.
“I really have seen us kind of as a safety net for the city, for the most at-risk kids,” said Rebecca Davenport, the clinical director for the Oral Health Program. “We’re able to connect them with that care, whether it be helping them find a home dentist, or helping them find the means to be able to afford payment for their care. It’s really significant.”
Members of the Oral Health Program presented to the San Antonio City Council’s Community Health Committee on Feb. 2, in hopes that additional city dollars could help the program continue despite the loss of funding.
Tooth decay in San Antonio
The city’s Oral Health Program has been around for roughly 50 years, starting with brick and mortar dental clinics around the city.
Metro Health started transitioning away from physical clinics into mobile services in the mid-2000s, partnering with UT Health San Antonio and the city’s Head Start program, which provides health, education and support services to young children and families.
Around 2012, the city health department closed its last clinic and started bringing the services directly to Title I schools — where the majority of students are considered economically disadvantaged — as well as Head Start and Early Head Start centers.
The rate of untreated tooth decay in third graders in San Antonio’s Oral Health Program was 37% during the 2024-25 school year, significantly higher than the state average of 24%, according to data from Metro Health.
“Many times it’s the first time [the children] have ever even seen a dentist,” said David Singleton, a retired dentist who worked in the program, during the meeting. “[Tooth decay] affects the whole health of the child. It’s really a life-changing thing for them.”
The COVID-19 pandemic upended the program’s incremental progress in bringing down the percentage of urgent cases in children. A case is urgent if the child is in pain or if there’s rampant tooth decay.
The percentage of school children with urgent cases had been coming down slightly in the years leading up to the pandemic to around 2.7% before jumping to 4.6% when the program resumed operations in 2022 after a two-year hiatus.
Not only were there more urgent cases, the urgent cases were often worse, Davenport said.
Common barriers to oral health include the cost of dental care, inexperience navigating the health system, lack of oral hygiene education and past dental trauma. Often, parents aren’t aware of the cavities and poor oral health until the children are examined through the program, Davenport said.
“I hear parents and grandparents tell their kids, ‘If you eat all of that candy, your teeth are going to get giant cavities, and then they’re going to have to pull out all your teeth,’” Davenport said. “You’re making what we do as dentists such a horrible thing. You’ve made them afraid to say that something hurts.”
Davenport said that bringing the dentists to children in a familiar environment is one of the greatest strengths of the program, given the fear surrounding dentist visits and the long-term health consequences whenever infections go untreated.
“Just above your top teeth, you have your brain, and if you point just below your bottom teeth, you have your throat,” she said. “I don’t want infection spreading to either of those things in my body, so it can end up being a life threatening, worst-case scenario.”
‘Dollars are tight’
The program has relied heavily on $1.4 million in funding made possible by the Medicaid 1115 waiver since around 2012. When the agreement expires in September, the program risks losing funding for 34 out of 39 staffers if the losses can’t be replaced from other sources.
“When we lose that funding, we’re losing the staffing that we need in order to operate the clinical preventative services that we’re doing currently,” Davenport said.
The program also receives $660,000 through grants and $400,000 through the city’s general fund. City leaders indicated a desire to keep the program afloat, but city budget constraints will make that challenging.
“Dollars are tight,” says Councilman Marc Whyte (D10). “To the extent that we can support the program in a reasonable way, I’m certainly for that.”
Metro Health Director Claude Jacob told San Antonio City Council members that the department is still looking for alternative funding avenues. The Oral Health Program is the third program to be impacted by the expiration of federal waiver agreements, the other two being the Healthy Neighborhoods Program and the Diabetes Prevention and Control Program.
“We’re missing opportunities to help these children, and that will lead potentially to increased rates of tooth decay among children in San Antonio,” said Meredith Howe, who manages the Oral Health Program. “We’re the only public health entity that provides this level of service, and so not being able to be a part of that would be a big loss for the city.”
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