Dental Reform

Our Most Precious Resource—Our Children

On Feb. 25, 2007 12-year-old Deamonte Driver of Largo, Md. died after his mother could not find a dentist to treat the child’s escalating tooth infection. 

A year after Driver’s death, the Maryland General Assembly approved sweeping legislation to overhaul the state’s Medicaid dental health system. 

Many of the reform measures adopted were recommendations made by the Dental Action Committee, (DAC), formed by the Maryland Department of Health and Mental Hygiene in response to Driver’s death and mounting concern over access to dental services.  MM!MD members former Public Justice Center Attorney Laurie Norris and Leigh Cobb, Advocates for Children and Youth Health Policy Director served on the DAC. 

On the national level, U.S. Sens. Benjamin L. Cardin (D-Md.) and Jeff Bingaman (D-N.M.) introduced legislation designed to provide greater dental services to children who lack insurance or who rely on state aid for coverage.  

According to Norris’ testimony before the Domestic Policy subcommittee of the Oversight and Government Reform committee, low-income children have about 80% of the dental disease in this country, and more than 50% of low-income preschool aged children in Maryland have dental decay, of which 98% is untreated. 

Data indicate that at the time of Driver’s death, two out of every three insured children in Maryland did not see a dentist in any given year. Driver had not seen a dentist in four years.  At the time Driver fell ill, his family's Medicaid coverage had lapsed.  Even on the state plan, his mother said, the children lacked regular dental care and she had great difficulty finding a dentist.

A University of Washington Department of Dental Health Public Services study, published in Oct. 2008, found that "for young children of black and Hispanic mothers, dental care use is higher when their mothers have a regular source of dental care.  For low-income young children with Medicaid, increasing the mothers' access to dental care may increase the children's use of dental and preventive services, which, in turn, may reduce racial/ethnic inequalities in oral health."

However, a state-by-state analysis by the Maryland General Accountability Office found that low reimbursement rates factored into the number of dentists unwilling to accept Medicaid patients.   

Medicaid payments in Maryland for common dental procedures ranged from 37 percent to 73 percent of the market rate, according to the report.  In addition, dentists expressed concerns over Medicaid population behavior issues and noncompliance with appoitments.  Only about 900 of Maryland's 5,500 dentists accept Medicaid.

In addition to spending increases, Maryland lawmakers also approved The Public Health Dental Hygiene Act (HB 1280/SB 818), which allows dental hygienists to perform cleanings, fluoride treatments and sealants in public health clinics and in schools without a dentist being present or requiring their sign-off.   

On Nov. 3, 2008 a group of dentists -- with help from the state and other groups -- announced the Deamonte Driver Dental Project.  It will pay for a van equipped with a dental facility to service low-income students in Prince George's County, where Driver was a resident.  .

"It's a dentistry on wheels, and it's going to be a full-service dental clinic," said dentist Dr. Hazel Harper. "We have the ability to do preventive services as well as restorative services."

The project also will increase reimbursements for dentists who provide treatment for patients on Medicaid.

The Centers for Medicaid and Medicare Services (CMS) held a Town Hall Forum in 2009 to explore access to dental services for Medicaid-eligible children.  The event brought together a variety of oral health stakeholders and was the first Town Hall forum on dental CMS has hosted. 

The agenda and discussion focused on how to address the lack of access to dental services for Medicaid eligible children and how to improve the delivery of services.

                                                  
Surrounded by a coalition of dentists,  state public health officers, DAC members, other advocates and Driver’s mother, Aylce, O’Malley announced new school based incentives including a mobile dental van for Prince George’s and  Montgomery Counties.  
 


Oversight Reform Committee Hearing Testimonies
http://domesticpolicy.oversight.house.gov/story.asp?ID=1282

Children’s Dental Health Improvement Act of 2007
http://www.care2.com/c2c/groups/disc.html?gpp=780&pst=487127
Senators Ben Cardin (D-MD.) and Jeff Bingaman (D-N.M.)

Linking Mother and Child Access to Dental Care
http://www.ncbi.nlm.nih.gov/pubmed/18829778       
Department of Dental Public Health Sciences and Health Services, University of Washington, Seattle Washington

New Initiatives to Improve Dental Care for Children http://www.hhs.state.tx.us/news/release/030508_CHIPMedicaid.shtml
Texas Health and Human Services

Senate Approves Legislation to Expand SCHIP Coverage
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=48626
         
http://www.Kaisernetwork.org
Election 2008

MM!MD Advocacy In Action

Involved

Focused

Collaborative

Results Driven

• Federal monitoring of states’ dental plans
• $7 million infusion to increase dental services in Maryland 
• 18, 250 more Medicaid enrolled children see a dentist in 2008 compared to 2007
• Maryland awards contract for single dental vendor to Doral Dental. 

Strategic

CA. Passes Slew of Health Care Reform Bills

Kaiser Family Foundation Briefing On Reform's Medicaid Expansion

Long Life for Health Care Reform? Maybe Not

BHCA Health Care Reform Impact Analysis

Health Care Reform: Confused? Join the Club!

MD Health Care Reform Coordinating Council

FamiliesUSA Health Care Reform Pre-existing Conditions Analysis

Kaiser Family Health Care Reform Subsidy Calculator

MM!MD is a Project of the Public Justice Center.

Public Justice Center, 1 North Charles Street, Suite 200, Baltimore, MD (410) 707-7845

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