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Dental Association Backs Medicaid Dental Reform

The landscape on oral health care for poor children in Maryland changed significantly on July 1, 2008, when a significant increase in Medicaid dental reimbursement rates went into effect. This event was marked in yesterday's Baltimore Sun by the following powerful OpEd from the Maryland State Dental Association. The PJC has provided leadership to this reform effort every step of the way. We are currently working with Maryland dentists and other interested parties to develop and launch a marketing and education campaign aimed at Maryland dentists to persuade more of them to get on board to begin serving our low-income children. One aspect of the campaign is a series of short video clips to be circulated by email. The pilot video clip can be viewed at http://youtube.com/watch?v=s7tGk2sZSGg. The OpEd is reprinted below.

www.baltimoresun.com/news/opinion/oped/bal-op.dental01jul01,0,1453539.story baltimoresun.com

Not in vain

After tragedy, Md. widens access to dental care — but we must do more

By Garner Morgan

July 1, 2008

No mother should ever have to bury a child. No child should ever die of a toothache.

That tragic and unnecessary fate befell 12-year-old Deamonte Driver and his family in Prince George's County. His death last year, when an untreated tooth infection spread to his brain, prompted an effort by Maryland to ensure that poor and indigent residents receive the type of preventive and restorative dental services that would have saved the boy's life.

Today, the state is finally infusing much-needed funds into the Medicaid system, to ensure care for children from disadvantaged families. As a result, dentists will be fairly compensated for caring for Medicaid patients, meaning more children can get the dental care they need, and wholly preventable or easily curable ailments won't become life-threatening conditions.

A $7 million-per-year cash infusion (matched by another $7 million annually from the federal government) will increase funding for Medicaid dental services over the next three years. Maryland is now on its way toward becoming a regional leader in oral care.

Funding has been so poor in this state that many dentists could not afford to provide care to Medicaid patients. In some cases, reimbursement rates were less than the cost to the dentist for the procedure. Yet Maryland dentists, whether they participate in the Medicaid program or not, routinely donate thousands of hours and hundreds of thousands of dollars each year to treating patients who cannot pay for services.

Now the state is augmenting the volunteer efforts of dentists and all oral health practitioners by providing additional funding to improve access to oral health, and the Maryland State Dental Association is issuing a call to action for its members to get involved. A study by the California Healthcare Foundation found that when states raised Medicaid reimbursement rates to a reasonable level, dentists' participation as much as doubled.

Red tape compounded the problem of dental services provided through Medicaid. However, the legislature made strides there, too. When a new statewide system comes on line a year from today, dentists and their Medicaid patients will have just one type of form to fill out, which has the potential to vastly simplify the administrative burdens on all concerned. The hope is that this encourages more dentists to participate in the Medicaid program and eliminates another barrier for families seeking dental care.

The state has also set aside additional funds in a grant program for Maryland's 23 counties and Baltimore to help local governments and nonprofits improve access to dental care for underserved populations. This money can be used to provide new dental services and providers through things such as building or renovating dental clinics, offering salary support for new dentists and dental hygienists, and developing private and public partnerships - for example, contracting with private dentists. It can also be used to provide transportation to dental offices and conduct community outreach programs to educate families on the importance of dental care.

However, much remains to be done. Maryland still does not provide dental services through Medicaid for adults. This neglect is evidenced in the fact that nearly 50 percent of residents living in households making less than $25,000 a year have not had their teeth cleaned in more than a year. Education programs are required to teach underserved populations about oral health and the prevention of oral disease. The state cannot increase services and automatically expect these populations to understand the value of dental health or how to follow through on oral health care between dentist visits.

Dental screening should be incorporated into the vision and hearing screenings done for public school children, or schools should require dental exams before kids are allowed to start classes. Additional training should be available to dental and medical providers to conduct oral health risk assessments and educate patients and parents on oral health. And even these are just the beginnings of a process that will bring oral care in Maryland to a respectable level.

Maryland has taken some very important steps to ensure all residents have access to dental care, but as the state wrestles over the next few years with larger health care issues, oral care must remain part of the forefront so that Deamonte Driver will not have died in vain. Ideally, we won't be remembered as the state that allowed a boy to die of a toothache, but as the state that did everything it could to ensure that other children avoided his fate.

Dr. Garner Morgan is president of the Maryland State Dental Association and a practicing dentist in Mechanicsville. His e-mail is gmorgan@olg.com.

Copyright © 2008, The Baltimore Sun

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