Since 1986, Apple Tree Dental had been providing dental care to elderly and disabled persons in nursing homes and community settings throughout the Twin Cities. In the late 1990s, Minnesota launched the Alliance of Purchasing Excellence (APEX), an initiative designed to combine publicly funded dental care programs (Medicaid, MinnesotaCare) with state employee dental benefits. Apple Tree viewed APEX as an opportunity to expand services into northwest Minnesota and agreed to participate in this new program by joining forces with Delta Dental.

Unfortunately, after Apple Tree invested considerable political and financial capital to setting up a clinic in the town of Hawley, the state decided not to go forward with APEX and Delta Dental backed out of the partnership, leaving Apple Tree financially at risk, with significant cash flow problems.

Apple Tree applied for and received assistance from Nonrofits Assistance Fund. “Without their help we wouldn’t be around,” said Dr. Michael Helgeson, executive director, Apple Tree. “The Primary Care Loan Fund helped us through a number of rocky periods when we weren’t ‘bankable’ and needed help with cash flow, due to delays in reimbursement and state rate increases when the Governor froze payments in 2004.”

In addition to providing Apple Tree with several loans totaling $280,000, Nonrofits Assistance Fund connected the organization with other foundation and financial resources, as well as providing technical assistance in the areas of nonprofit management and rural health care finance.

Looking ahead, Apple Tree sees an ongoing need for the MPC, particularly for clinics that lack a predictable stream of revenue due to state payment fluctuations. Apple Tree currently operates two rural and one metro-area clinic in addition to their mobile care. Furthermore, providing dental care to 14,000 patients, many of them public assistance clients in a managed care system, creates a unique set of political and financial dynamics that often leave dentists at the mercy of policy decisions that impact their short and long-term financial sustainability.