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.

Today is National Bike to Work Day, and while it may sound "easier said than done," it may not be as daunting as you think.

Enthusiasts said the benefits of commuting by bicycle outweigh the drawbacks. Besides saving money on gasoline and vehicle expenses, research suggests it can increase productivity on the job by improving cognitive performance and lowering stress.

Chuck Smith, chair of the Ohio Bicycle Federation who lives in Vandalia, logged more than 50,000 miles in 22 years on his bike commuting to his job at Wright-Patterson Air Force Base. He explained there are more than 300 miles of connected paths in the region, which makes cycling a practical way to get around.

"Got out early in the morning and I had a good hill to go down," Smith recounted. "On a chilly morning, if that didn't wake me up, nothing would. And then the Great Miami Trail I took on the way home from work. It improved my outlook. Just a wonderful thing."

For especially long commutes, advocates suggest mixing biking with public transit. Nationally about 0.5% of workers ride a bike to work, and 20% of all bicycling trips are to "earn a living."

Lack of sidewalks and paths, traffic volume and speed and unsafe motorist are the top barriers to biking for most Ohioans.

Smith explained his group advocates for policies to improve safety for cyclists and communities.

"Things like bicycle parking; very important that businesses have those," Smith asserted. "We're really concerned about pushing to make the penalties higher for distracted driving and to make it a primary offense, so a distracted driver could be pulled off the road just for doing that."

Ohio has more than 3,000 miles of bike routes, but there are gaps in state, regional and local networks. The Walk.Bike.Ohio plan was launched in 2021 to improve connectivity and safety.

Smith encouraged Ohioans to consider cycling for both transportation and recreation.

"A bike is definitely the best way to tour," Smith contended. "You can see things much better from a bike, a full 360-degree view of things versus a car where you're really limited. Really, cycling is the best way to do so many things."

At the federal level, there are efforts to reinstate a bicycle commuter tax benefit of up to $20 a month, which was eliminated in 2018.

Reporting by Ohio News Connection in association with Media in the Public Interest and funded in part by the George Gund Foundation.

A new report urges states to take steps to minimize Medicaid coverage loss when the state of emergency for the pandemic comes to an end.

COVID relief legislation in 2020 implemented continuous coverage for Medicaid through the public health emergency, meaning people could not be kicked off while the emergency remained in effect. It is set to expire in July, but the Biden administration has said it will give 60 days' notice, so it is likely to be renewed until at least October.

Farah Erzouki, senior policy analyst for the Center on Budget and Policy Priorities and co-author of the report, noted many people's contact information has changed during the pandemic, and it is important for agencies to recognize it.

"Millions of people have faced housing instability; many people have moved," Erzouki pointed out. "In addition to that, many and probably most people haven't been in touch with their agencies since the start of the pandemic because they haven't needed to take any action to keep their coverage from getting terminated."

The report includes a variety of recommendations, including sending updates on the renewal process by text or email as well as by mail. New Hampshire allows participants to opt into text notifications for Medicaid and the Supplemental Nutrition Assistance Program (SNAP), at nheasy.nh.gov.

Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center and a co-author of the report, echoed there are many opportunities for people to lose coverage despite remaining eligible. She added the increased workload might cause agencies to fall behind in answering calls and processing paperwork.

"These administrative burdens, that are part of a poorly executed renewal process, fall disproportionately on people of color, who are more likely to rely on Medicaid due to historic discrimination and overrepresentation in low-wage work," Wagner explained.

The report indicated for people who become ineligible for Medicaid because of increased income, it is important for agencies to help them access Marketplace coverage. It also recommended conducting outreach and obtaining updated contact information by partnering with other agencies, such as the U.S. Postal Service and community based organizations, as well as to ensure materials and messages are easy to understand and available in multiple languages.

At the start of the pandemic, at-home caregivers in Washington state saw their wages go up with a boost from hazard pay. Two years later, inflation is erasing the pay bump.

Wages actually have gone up for caregivers from $19 per hour in May 2020 to $19.26 today, but inflation means the purchasing power of their pay now is actually $17.46.

Gwen Goodfellow, an at-home caregiver, said the increase was welcome at first.

"Having the hazard pay was really nice. It made us feel more comfortable to do, like, grocery orders instead of going to the store and allow us to be a little bit more protective," Goodfellow acknowledged. "Then, as time went on, the cost of things went up, and it's not a bonus at this point."

Goodfellow's union, Service Employees International Union Local 775, was instrumental in negotiating hazard pay for caregivers. Hazard pay was offered to essential workers who were in vulnerable positions as COVID-19 spread.

Goodfellow looks after her mother and a friend, as well as taking care of her son, and pointed out caregivers are struggling.

"Good pay for caregivers is really important," Goodfellow asserted. "I mean, we help seniors, we help people with disabilities. I know my situation isn't unique. I hate to say it, but sometimes it feels like I kind of almost chose poverty so that I could care for my family."

Goodfellow added benefits beyond pay are important as well, such as affordable health care, retirement and paid time off which does not inhibit her ability to pay the bills.