The Hope Dental Clinic was born 60 years ago in the basement of Union Gospel Mission’s men’s campus outside downtown St. Paul, offering free tooth extractions and emergency dental care to the homeless and others in need.
In 2018, after losing its space when the St. Paul shelter refocused services, Hope Dental incorporated as its own nonprofit, attracting an active roster of some 400 dentists, dental students and other volunteers to its Minnehaha Avenue offices on St. Paul’s East Side.
The effort drew some 2,500 patients last year alone, many of them indigent and uninsured, but at no small cost. Maintaining the clinic requires some $100,000 monthly, an amount that Hope Dental’s nonprofit board has been hard-pressed to maintain. The grant-funded clinic closed Dec. 12, ending an era that some hope could yet be revived.
In her day job, Dr. Linda Maytan is the Medicaid dental director for the state of Minnesota. She’s keeping fingers crossed that a major donor could yet step forward with a multimillion-dollar gift and reopen Hope Dental, if not acquire it outright. That would be a tall order, but not unprecedented in the world of nonprofits.
“We’re open to anything,” said Maytan, who chairs the nonprofit’s board of directors. “Obviously, it would be great to have somebody endow us so we could have constant income, in addition to our grants. Or we’re open to a business model where someone would say, ‘Hey, we’ll take you over and still run Hope three nights a week.’ The board hopes someone doesn’t just come in, take it over and run it like a dental practice.”
Maytan, who has served on the board since Hope Dental began seeking its own nonprofit status in 2016, said there are few dental care clinics that operate around the same free, nonprofit model, and Hope Dental was easily the largest of those in the state. The clinic handled extractions, root canals, fillings and sometimes denture care. Every now and then, they ran a free tooth-implant clinic.
After years of going without regular dental care, patients walked in the door with infections and ruptures. A female patient who had four teeth removed and several cavities filled at Hope Dental in January 2023 told the nonprofit she hadn’t been to a dentist in 40 years, partially out of fear, but finally broke down when she could no longer take the pain.
Extractions were “pretty much 90% of my day,” said Dr. Natalie Gomez, the clinic’s dental director. “A lot of them are severely infected teeth that patients haven’t had the chance to treat properly.”
From the working poor to retirees, homeless and vets
Mostly, Hope Dental dealt with poor people in terrible pain.
“Our goal is to get patients in, solve the immediate problem, stabilize them dentally and then graduate them off to a dental home,” Maytan said. “Hope is not designed to be someone’s day-to-day dental provider. … It helps them launch into the Medicaid space or another place where they can receive services.”
The types of patients varied, but almost all lacked insurance.
Some were the working poor — individuals who made too much money to qualify for Medicaid. Some were undocumented immigrants. Many were homeless. Some had substance abuse disorders. About 65% of patients were people of color, with a large percentage of them Latino.
The VA Health Care System offers some dental services for military veterans, but capacity is limited. Hope Dental worked with the American Dental Association’s new “Give Veterans a Smile” program to offer pro bono oral health care to underserved veterans. Three times annually, the clinic hosted “Give Kids a Smile” events aimed at children.
Still other patients were simply everyday seniors, many not realizing until too late that Medicare does not contain an automatic dental benefit and treats dental insurance as an add-on.
“Most people don’t know that, so they retire and go, ‘What?’” Maytan said. “A lot of patients receive services who wouldn’t have anywhere else to go. We’re the safety net for the safety net.”
Before cash ran low, the goal had been to work with more seniors living in low-income housing and to explore tele-dentistry, offering remote care — such as screenings and assessments — as a first step toward matching patients to long-term providers.
In addition to 10 paid staff, the clinic — which offered services four nights per week and two full clinic days — drew from an active roster of 400 volunteers, including dental hygiene students, dental assistants, dental therapists in the same vein as nurse practitioners, retired dentists, dental school faculty and dental school internists, or medical residents undergoing an extra year of training. Some dentists arrived as part of continuing education programs.
A changed fundraising environment
All of that came to an end on Dec. 12.
Fundraising has been tight since the pandemic, but Gomez said the final straw was when the Otto Bremer Trust declined last year to renew what had been a major reoccurring grant. About 45% of the nonprofit’s budget in 2023-24 was grant-based, and another 36% came from individual and nonprofit donors.
Gomez noted that seeking grants has become especially difficult for nonprofits in the past year or two, almost across the board, even as a labor shortage and inflationary economy have bitten into the bottom line for many charities.
“A lot of the grants went to ‘invite only,’ so they’re just being very particular,” Gomez said. “A lot of the granters don’t even recognize us as eligible because we don’t have a designation as a federally qualified health care clinic. … Things have changed a lot in the grant world.”
That sentiment is shared across the nonprofit industry.
A June 2024 report from the Minnesota Council of Nonprofits found that the vast majority of nonprofits surveyed — some 79% — predicted they might reach a state of financial distress within the next 12 months, given the current funding environment. That’s up from 47% in 2022.
The most common reasons cited included increased expenses, fluctuations in charitable giving and COVID relief funding being mostly distributed and spent.
Also in December, a Burnsville clinic that served the uninsured — Dakota Child and Family Clinic, previously known as Mendota Health — closed its doors permanently, just months after being acquired by the nonprofit Open Door Health Center in Mankato.
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