Appointment after appointment, Ryan, a Typical Life Corporation Direct Support Professional, drove the individual who lives in one of the organization’s residences to the dentist, where decades of decay slowly was drilled out. The treatment wasn’t covered by insurance or state funding. It was all paid out of pocket, and persuading the individual to choose having dental work done over booking a cruise or buying new shoes had been a struggle.
Still, Ryan kept at it, and today the individual he serves wakes up with a brighter, healthier smile. Despite the gaps in health insurance coverage facing many of TLC’s individuals, the organization is finding innovative ways to support its neurodivergent adults when their benefits fall short.
“We take care of the whole, entire person,” says TLC Chief Executive Officer Sandy Chilton.
A deep-rooted problem
As with the individual Ryan serves, a primary area of concern for many individuals is dental care. Many neurodivergent adults, especially those who had lived in institutions, received little to no dental care. Others take medications that have destroyed their teeth. State insurance covers two checkups per year, but coverage for more extensive dental work often is nonexistent. This lack of coverage can lead to severe health issues.
Additional medical expenses beyond the actual treatment also pose a hurdle. Typically, the individuals TLC serves have state-funded insurance. Many experience anxiety when it comes to dental or medical appointments, but sedation often isn’t covered. General anesthesia for dental work is extremely expensive and often must be paid out of pocket.
“I don’t think people truly understand the significance of dental care,” says Tiffany Kauffman, Chief Operations Officer. “It can land them in the hospital and cause significant regressions, all from a tooth issue. Many individuals have a hard time expressing pain, so routine checks are crucial.”
Finding providers willing to accept state insurance and treat neurodivergent individuals is another challenge. Often, when TLC locates willing providers, the amount of work needed can inundate them quickly. They soon set limits on how many individuals they will treat.
A collaborative effort for care
Despite the hurdles, TLC pursues various solutions to gaps in dental and health care for individuals they serve, often bridging the financial divide through internal funding and payment plans.
Identifying and prioritizing the gaps in care have become a collaborative effort at TLC, involving extensive conversations among an individual’s Direct Support Professional, the broader TLC team, and the individual’s family and loved ones.
The TLC financial team, led by Chief Financial Officer Jonelle Gabsewics, works closely with individuals and their families to set up payment plans and provide financial guidance. Every individual has unique needs, physically and financially. TLC’s personalized approach ensures that necessary medical care is accessible to all who need it.
By keeping everyone on the same page when it comes to health care, TLC is able to better predict needs and prepare for them, rather than simply react. The organization can see where the outliers and additional expenses are, especially for those in TLC residential care.
Community collaboration
Working with health care providers and organizations is key to TLC’s strategy. Being upfront with providers about individuals’ needs greatly helps, says Tiffany. The TLC team tries to be open and honest about each individual’s situation, which helps build community connections.
“We want to create partnerships with community members and support as many people as possible,” Tiffany says.
TLC’s vision for the future includes establishing a medical needs fund to plug financial gaps related to essential items and care. The organization plans to educate stakeholders and encourage donations to help pay for services not covered by insurance. While the task is challenging, TLC is dedicated to closing the gaps in care for neurodivergent adults through innovative solutions and community collaboration.
TLC’s approach already is leading to success. The improved health and self-esteem of the individual whom Ryan drives to dental appointments are evident every day.
“He tells everyone how good he feels now that the work is done,” Jonelle says. “It’s a huge success for us.”