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Dental Reform Movement Pushes On

By Mary Otto

Washington Post Staff Writer

Monday, September 10, 2007; B01

Six months ago, the death of a 12-year-old Prince George's County boy from untreated dental decay shed a grim spotlight on gaps in federal and state medical assistance programs charged with providing care to 30 million poor children.

Deamonte Driver gave a face to the two-thirds of Medicaid children who receive no dental care, and his name became a rallying cry for a multitude of reform efforts now unfolding.

A congressional inquest that began in May with lawmakers angrily interrogating federal health officials and insurance executives continues to probe failings in the system. This month, members of Congress will push ahead with a bill that would strengthen dental care for the children of the working poor. And tomorrow in Maryland, officials will receive new recommendations for a major overhaul of the state's Medicaid dental program that serves nearly 500,000 poor children.

"In letters and speeches, we all mention Deamonte Driver," said Rep. Elijah E. Cummings (D-Md.). "We want to keep the memory of this boy alive. We want to make sure that life comes out of his death."

Maryland's eight-member Democratic congressional delegation says it plans to fight to get a guaranteed dental benefit included in the reauthorization of the State Children's Health Insurance Program, or S-CHIP, a decade-old federal-state program set to expire Sept. 30.

The dental guarantee and several other related provisions are in a House version of a bill that must be reconciled with a Senate version. The Senate does not include the dental guarantee but does have an amendment, sponsored by Sen. Benjamin L. Cardin (D-Md.), that would authorize $200 million in grants to states to improve dental care for children. The entire bill, however, remains under a veto threat from President Bush.

Another bill awaiting approval, sponsored by Rep. Albert R. Wynn (D-Md.), would provide tax credits for dentists serving the poor and $3 million annually for four years for outreach projects in areas with few dentists.

And Cummings is sponsoring a measure that would authorize $10 million annually for four years to support the hiring and training of dentists serving poor communities. He is calling it Deamonte's Law, he said, because the tragedy struck a personal chord for him.

"As a young boy, I grew up in a very poor family. . . . This story brought back a lot of painful memories," Cummings said. "I used to think toothaches were just a part of living."

Cummings and other members of a congressional subcommittee also are continuing to press for answers about shortcomings in federal and state management of the Medicaid program. At a May hearing, the panel probed the barriers Deamonte's mother, Alyce Driver, faced in obtaining dental care for her children in the months before Deamonte died after an infection from an abscessed tooth spread to his brain.

"Federal law requires these services be made to children," Rep. Henry A. Waxman (D-Calif.), chairman of the committee on oversight and reform, said as he angrily questioned a Medicaid official. "You're not doing a good enough job if two out of three kids do not get pediatric dental care and they are eligible for it.

"Don't you have any responsibility for this? Do you have a suggestion for changing the law? Is there any reason you're not enforcing the law?" Waxman asked.

Dennis Smith, director of the federal Center for Medicaid and State Operations, said it was the states' responsibility to meet the requirements.

In an Aug. 27 letter to Smith, Cummings, with subcommittee Chairman Rep. Dennis J. Kucinich (D-Ohio), renewed demands that the federal agency conduct a critical-incident review of Deamonte's death and use its powers to force states to provide the routine and restorative dental services to which poor children are entitled by law.

A spokeswoman for the Centers for Medicare and Medicaid Services said Friday that the center is "working on a response to the questions" from the subcommittee.

"We are, of course, concerned that children in the Medicaid program get prompt and proper attention to their medical and dental needs," spokeswoman Mary M. Kahn said.

In Maryland, a panel of experts convened by state Health and Mental Hygiene Secretary John M. Colmers will deliver a report tomorrow that will recommend a broad restructuring of the state's Medicaid program reduce bureaucracy. It will also call for spending $40 million more a year to raise reimbursement rates for dentists.

The Dental Action Committee -- an appointed group of health providers, insurance and health officials and children's advocates -- will recommend that a single administrative service organization be in charge of all Medicaid dental care for children and pregnant women in Maryland and work directly under a contract with the state Health and Mental Hygiene Department. Currently, dental care is handled by subcontractors for several managed care organizations.

The state health department would cover dental claims instead of the managed-care organizations, explained Baltimore lawyer and children's advocate Laurie Norris, a member of the panel.

The committee also recommends spending $40 million -- about half state and half federal funds -- annually to significantly raise reimbursement rates paid to dentists participating in Medicaid as a way of encouraging more dentists to treat poor children.

Maryland's Medicaid reimbursement rate for such restorative procedures as fillings for cavities ranked lowest in the nation in 2004, a deterrent to many dentists to participate in the program. Fewer than 16 percent of Maryland's Medicaid children received such services in 2005, the most recent year for which figures were available.

The committee's recommendations "are what the state needed years ago," said committee member and state dental association president Garner Morgan.

To prevent another child's death, the work will need to continue on all levels, said another committee member, Prince George's Health Officer Donald Shell.

"This is an all hands on deck issue," he said. "With problems so pervasive and so challenging, its going to take efforts on all fronts to make a difference."

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