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Budget Approved to Increase Dental Care for Maryland Children

Following is an article in the Washington Post heralding the advances made to ensure dental health for Maryland’s children. PJC Attorney Laurie Norris and Policy Director Mark McLaurin were instrumental in working with a coalition of children’s advocates to increase funding in the Maryland FY2009 budget for a comprehensive plan to provide dental services to the 500,000 children receiving public health insurance. Funding was also approved to raise reimbursement rates for dentists in order to encourage more dentists to treat children, to expand dental services through county clinics, and to allow dental hygienists to provide preventive dental services in schools, Head Start centers and other public health settings.

Dental-Care Access Expands
To Help Poor Children, Md. Increases Medicaid Rates Paid
By Mary Otto
Washington Post Staff Writer
Sunday, April 20, 2008; SM02

Advocates for children's dental care were biting their nails through much of Maryland's recent General Assembly session. But despite a flurry of spending cuts, millions of additional state dollars aimed at expanding dental care for poor children made it into the state's budget for the coming fiscal year.

"Everything we asked for, we got," said Harry Goodman, who directs the Office of Oral Health for the state Department of Health and Mental Hygiene.

The added funds, which will be used to boost rates paid to dentists who treat Medicaid children and help expand public dental care in underserved areas, are part of a long-term strategy to provide more dental care to poor children throughout the state.

The death of a 12-year-old Prince George's County boy last year from complications of an untreated dental abscess cast a light on the failings of Maryland's Medicaid dental program. Although Medicaid, the nation's health insurance program for the poor, entitles children to dental care, fewer than one-third of Maryland's Medicaid children were seen by a dentist in 2005, a statistic that is typical of the problem nationwide.

The barriers to dental care are complex, but one contributing factor has been the shortage of dentists willing to accept Medicaid patients. Many have cited the state's historically low Medicaid reimbursement rates as a deterrent to providing services.

In what is intended as the first of three annual installments to raise the rates, lawmakers approved $7 million in new state funds, to be matched by $7 million in federal Medicaid money, for the coming year. The increases are intended to ultimately provide $42 million in state and federal funds to bring Maryland's Medicaid dental-care reimbursement rates up to the median for the region.

The state budget also includes $1.4 million to increase the capacity of local public health clinics to provide dental care, particularly in underserved areas of the state, such as Southern Maryland and the Eastern Shore. In addition, $700,000 will be dedicated to establishing school-based programs, including a mobile dental services program.

Dental hygienists working in public health settings will have more freedom to get needy patients into care, thanks to another bill passed during the legislative session. The measure, scheduled to go into effect Oct. 1, allows public health hygienists to provide preventive care, such as cleanings, sealants and fluoride treatments, to patients in the facilities where they work, as well as in schools, Head Start programs and other settings, without the authorization or direct supervision of a dentist, which state law required previously.

Where dentists are unavailable to initiate care, the wider use of public health hygienists "could stop the bottleneck" in getting patients into the system, said dentist Norman Tinanoff, a health policy expert at the University of Maryland Dental School.

Leigh Stevenson Cobb, health policy director for Advocates for Children and Youth, a statewide group, agreed.

"This allows the hygienist to go out and start some preventive treatment and refer the child on to the dentist. It's just a more time- and cost-effective mechanism for getting treatment to kids who are underserved," Cobb said. "It's a very good thing. "

The spending measures and the expanded use of hygienists were included in a reform plan prepared by a panel of health-care providers, insurance and government officials and children's advocates that was convened last year, after the death of Deamonte Driver, 12.

The plan, which also called for a restructuring of the state's Medicaid system, is moving forward, Goodman said.

"It has been an amazing effort," Goodman said. "Now it is time to implement these changes."

© 2008 The Washington Post Company

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