Purpose: Childhood caries disproportionately effects children who are poor, live in low-income rural and urban areas, and come from racial and ethnic minority groups. The purpose of this study was to explore the effect of public policy related to dental hygienists' level of supervision and policy uptake at the state level on the organization, delivery, and financing of school-based oral health programs (SBOHP). Methods: A multiple case study methodology was used to compare SBOHPs in the states of Missouri and Kansas. Interviews were conducted with an administrator, dental hygienist, and dentist at each Federally Qualified Health Center (FQHC) that operated a SBOHP. Mixed methods were used to conduct and analyze interviews, examine supporting documents, and to report descriptive details. Analytic categories were used to examine the various facets of the organizational structures, delivery processes, financing and billing, and operations. Results: Five themes revealing differences between two states emerged; historical development of SBOHPs, the structure of SBOHPs, staffing and professional relationships, finance and billing, and capacity of school-based oral health network. Conclusion: Dental hygienists' supervision requirements play a critical role in school-aged children's access to oral health services and the capacity of SBOHPs. The variations in the degree of practice autonomy accorded to dental hygienists under the Missouri and Kansas dental practice acts resulted in different oral health delivery models. Greater autonomy for dental hygienists is essential for realizing the promise of dental public health. Keywords: access to care, school based oral health programs, dental public health, dental hygiene workforce models, health policy. This manuscript supports the NDHRA priority area Professional development: regulation (scope of practice). Submitted for publication: 10/2818; accepted 3/12/19, Introduction The epidemic of childhood caries, a completely preventable disease, was highlighted in the 2000 United States (U.S.) Surgeon General's report, Oral Health in America. (1) In the nineteen years [...]