AUGUSTA, Maine. -- As Maine works to expand access to dental care for low-income residents, health-care advocates say lessons can be learned from other states that already cover dental care under their Medicaid programs, and from Mainers who'll be personally affected.

The state budget signed into law last week extends comprehensive and preventive dental care to more than 200,000 people under the state's Medicaid program, MaineCare.

Kathy Kilrain del Rio, director of campaigns and healthcare advocacy for Maine Equal Justice, said the next steps are deciding what this will look like in practice, and rulemaking, before it goes into effect in July 2022.

"Maine was actually in the minority of states not having any type of preventive or comprehensive dental benefit," Kilrain del Rio pointed out. "So, I think we can look at what's worked in other places."

She noted oral health has many implications for a person's overall health, from heart health and diabetes to self-image and mental health.

More than 35% of low-income Mainers who responded to a survey said the condition of their mouth or teeth affects their ability to interview for a job.

Kilrain del Rio added the most powerful voices in pushing this bill through the Legislature were those who are affected by lack of dental care.

She hopes rulemakers continue to listen to them as they outline the process for accessing care.

"This is really a game-changer," Kilrain del Rio remarked. "People will have access to cleanings and to be able to get their cavities filled, and all the other types of care that, I think some people at least, take for granted."

A report from the Health Policy Institute also showed improved oral health leads to lower average medical costs for MaineCare members with diabetes or heart disease or those who are pregnant.

By improving people's health and self-confidence, it could generate economic benefits, especially in rural areas.

Nebraska's long-term care facilities face staffing shortages and other factors that could lead to more closures if state funding isn't increased.

An estimated 400,000 people nationwide have left this facet of the health-care industry since the pandemic began.

In Nebraska, the long-term care crisis has already led to closure of 44 nursing homes and 35 assisted-living facilities since 2015, the majority in rural communities.

Jalene Carpenter, president and CEO of the Nebraska Health Care Association, said others remain at risk of closing their doors.

"We have people needing services, wanting services," said Carpenter, "but the facility is struggling with staffing and is not able to accept additional residents, because they're having to care for the ones that they already have living with them."

Carpenter explained that when facilities can't serve new residents, they struggle to remain financially sound.

She citeed the low unemployment rate, the high inflation affecting food and supply costs, and the state's inadequate reimbursement rate for Medicaid residents as other contributors to this crisis.

Gov. Jim Pillen's proposed budget includes no increase in Medicaid rates, which Carpenter called "incredibly concerning."

Carpenter said the reimbursement rate is critical, since 60% of Nebraska nursing home residents rely on Medicaid to pay for their care.

She described them as "hard-working Nebraskans" who paid their taxes - but now, need expensive care and have run out of resources. She added that when a facility closes, it affects not only the residents and their families - but the local economy as well.

"Healthy education, healthy businesses, and healthy access to all levels of health care, and long-term care is a really important part of that," said Carpenter. "Yes, it is an incredibly expensive form of care, but it's also so critical to our society that we have access for seniors, to that care."

Two bills to increase the Medicaid reimbursement rate have been introduced this legislative session - LB 129 for nursing homes and LB 131 for assisted living facilities. Carpenter said she believes the future of some of these facilities depends on the fate of those bills.

February is National Heart Month, and doctors want Virginians to understand heart health a bit better - specifically, heart attacks and cardiac arrest.

According to the Centers for Disease Control and Prevention, more than 800,000 people have heart attacks every year, and the majority are first-time heart attacks. Cardiac arrest can involve numerous factors, and heart attack is the most common.

Dr. Benjamin Galper, assistant chief of cardiology at Mid-Atlantic Permanente Medical Group in northern Virginia, said this is partly why the two get mixed up. He said typically, signs of a heart attack can be chest pressure, nausea or sweating - but the signs of cardiac arrest are more dire.

"Cardiac arrest, itself is not subtle," he said. "If you've gotten to the point of cardiac arrest, it means the person is unconscious, that they don't have a pulse when you take their pulse and they're not breathing. So, when someone's had cardiac arrest, it's usually obvious and usually quite concerning."

National Heart Month is a good time to commit to reducing those risks, with a heart-healthy diet and regular exercise. Galper also encouraged people to get CPR training, to be able to aid someone having a heart attack until first responders arrive - and possibly save a life.

Underlying diseases such as diabetes or prediabetes can make a person more susceptible to heart problems. Dr. Ravi Johar, chief medical officer at UnitedHealthcare, said genetics can be another risk factor.

"Things like Marfan Syndrome increases the risk of aneurysms and abnormal blood flow to the heart, and things of that sort, so there can be some genetic consequences," he said. "There can also be genetic history; if your parents had problems with their hearts, there's a higher likelihood that you may."

He added that heart disease can affect people at any age. CDC research has found it can start as early as 35, and the risks increase with age. Anyone experiencing new chest pains or shortness of breath is encouraged to talk with their doctor about their heart-health options.

With Black History Month underway, Wisconsin researchers and support groups are highlighting the disparities in cases of Alzheimer's disease.

The Centers for Disease Control and Prevention said older Black Americans are about two times more likely than whites to have Alzheimer's and other dementias.

As drugs designed to treat conditions accelerate toward the market, the University of Wisconsin School of Medicine and Public Health noted Black adults are less likely to be included in the research. The school has made it a priority to focus on the Black population in an ongoing study.

Diane Beckley Milner, director of diversity, equity and inclusion for the Alzheimer's Association Wisconsin Chapter, said participation is important.

"Without us being involved in those clinical trials as Black Americans, then the research, it's not going to lend itself to giving accurate information," Milner pointed out.

The university acknowledged Black individuals can be reluctant to participate in studies, citing historical trauma from events such as the Tuskegee experiment. Officials say when it comes to the UW study, Black volunteers account for 27% of the people enrolled, which is much higher than the state's Black population, suggesting it provides hope in boosting research inclusivity.

Milner emphasized partnerships her group has with organizations such as the African Methodist Episcopal Church can help ease fears and create more awareness within the Black community.

"Having that partnership has proved to be very, very important and critical to making sure that people get information that they can trust," Milner explained.

She added a common challenge her group has found in outreach is many Black Americans view cognitive decline as simply a sign of aging, and not a disease. The association also works with nursing organizations in hopes of educating more people within the Black population.