Dental Care Improvements Threatened by Budget Cuts

By VEENA TREHAN, Capital News Service

WASHINGTON- One year after a Prince George's County boy died from untreated tooth decay, Maryland's fledgling efforts at improving access for low-income children to dentists are being threatened by the state's budget woes.

Deamonte Driver's cavity caused a brain infection that killed the 12-year-old after a six-week hospital stay. What could have been solved by an $80 tooth extraction, took a life and cost taxpayers $250,000, and it garnered international attention for the weak dental care experienced by many poor American children.

Since the boy's death, state and federal lawmakers have begun working on the problem.

Congress has:

- held hearings in May 2007 and February 2008 evaluating the state of pediatric dental care;

- passed a children's health care bill giving dental care to uninsured families, only to see it vetoed by President Bush;

- proposed a funding bill Thursday co-authored by Rep. Elijah Cummings, D-Baltimore.

But Maryland experts predict the greatest impact will come from the state, by instituting the seven recommendations of the Dental Action Committee formed last May. They aim to establish a "dental home," or consistent source of dental care, for poor children. Those recommendations are:

-- Replace Maryland's multiple Medicaid dental care providers with a single one by July 2009.

-- Increase Medicaid dental reimbursement rates to the regional average to encourage dentist participation.

-- Expand the network of public dental facilities.

-- Allow dental hygienists to provide some dental services.

-- Develop a unified message for parents and caregivers.

-- Ensure public school children get dental screenings.

-- Train pediatricians and dentists to assess children.

It's not known what the final cost will be, however initial one-time costs are expected to run about $26 million, with continuing costs projected at $40 million per year. The state pays about $33 million now for Medicaid dental costs.

Maryland approved $16.1 million for 2009, an "absolute minimum" according to Dental Action Committee member Leigh Cobb.

And because these initiatives fund new - not existing programs - they are especially threatened as the state tries to close a predicted $300 million shortfall.

Had four of the recommendations been in place—consolidating contracts, raising rates, expanding public facilities, and improving medical screening - supporters said Deamonte could have been saved.

Deamonte's death was caused in part by an inadequate supply of Medicaid dentists, although on paper the numbers look sufficient.

Maryland requires each Medicaid provider to maintain a list of dentists who serve no more than 2,000 kids. But lists aren't maintained and contain dentists who have moved, stopped taking insurance or won't enroll new patients.

Last year, Ohio Democratic Sen. Dennis Kucinich found none of the 24 dentists listed in UnitedHealthcare/AmeriChoice's Prince George's County network would have helped Deamonte.

Maryland pediatric dentist Norman Tinanoff also testified that only one-fifth of Medicaid-listed dentists would treat a new patient.

In fact, for Deamonte's brother DaShawn, it took four professionals working together to get him an appointment to pull a tooth.

A later investigation found about 10,000 Maryland kids enrolled in UnitedHealthcare/AmeriChoice hadn't seen a dentist in four or more years, meaning the premiums paid to the company by the state were left unused.

Harry Goodman, director of Oral Health for the Maryland Department of Health and Mental Hygiene, said the new structure will improve accountability and oversight.

"It demonstrates to the dental community we are serious and simplifies the process for dentists and the public," said Goodman. "It's a more seamless and transparent process for everybody."

New reimbursement rates should also make it more attractive for dentists to participate in Madicaid.

For most services, Maryland pays dentists less than half the regional average, and many services fall much lower than that - below the 10th percentile.

Current funding is not sufficient, lawmakers were told.

"Maryland grossly underfunds medical care," said Dr. Burton Edelstein, chairman of the board of the Children's Dental Health Project, at a Feb. 14 congressional hearing.

The recommendation is to up dental reimbursement rates to the region's average. Medicaid funding is slated to go up $14 million, to about $47 million, roughly a 50 percent increase. The requested $42 million increase would be more than a doubling of this budget.

Even so, private dentists will not be able to keep up with demand so the committee recommended public dental facilities for each county at a cost of more than $26 million over the next five years.

Five Maryland counties now lack any public infrastructure, with rural areas the worst. The Rural Maryland Council found last year that rural Maryland children experienced twice the rate of total tooth loss as the rest of the state.

The state budget contains $2.1 million to build clinics in Southern Maryland and the Upper Eastern Shore, and to provide mobile services.

Particularly important will be reaching children through schools.

In the Head Start program, which reaches about 40 percent of the state's poor children, half of the children have untreated cavities.

Head Start must establish "dental homes" but cannot because federal funding is insufficient, said spokesman Luis Burguillo.

Head Start recently announced a five-year effort to educate students and parents and provide a consistent dental resource to promote a national culture of prevention.

Helene Fisher, mother of a 4-year-old boy at a Head Start center in the District, said the program is unique and an important way to reach a lot of parents who don't realize the importance of good dental health.

"They are doing it from the child up versus from the adult down," said Fisher. "A lot of people underestimate the power of the child to educate."

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