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PJC Testifies Before US Congress on Dental Health

On May 2, 2007, PJC Attorney Laurie Norris testified before a subcommittee of the U.S. House of Representatives to tell the story of Deamonte Driver, the 12 year old who died of an infected tooth, and the struggles of his family to find a dentist and oral surgeon who would accept Medicaid. Click here to read Laurie's testimony, which is recommended reading for everyone who wants to understand the difficulties a poor family has in finding medical care. For example, she called 26 dentists who were on the list of doctors who would accept Medicaid patients, but none of them in fact would. She concluded that "[i]t took the combined efforts of one mother, one lawyer, one helpline supervisor, and three health care case management professionals to make a dental appointment for a single Medicaid-insured child!" The story of Deamonte's family is typical, not an aberration: low-income children have about 80% of the dental disease in this country; more than 50% of low-income preschool aged children in Maryland have dental decay; and 98% of that dental decay is untreated, each child having an average of 3 untreated cavities; only 31%-45% of Maryland’s continuously enrolled Medicaid children ages 4-20 (representing perhaps half of Maryland’s Medicaid children in that age group) saw a dentist in 2005; and only 13%-16% of those children got any restorative treatment (e.g. filling for a cavity). Laurie observes that "[t]he problem of access to oral health care for poor children has been a long-standing one and has been studied extensively. As a result of all this study, we know what causes children to become infected with oral bacteria leading to dental caries. We know that the disease is a systemic, endemic, chronic and epidemic problem among poor children. We know the nature of the numerous obstacles to ensuring that poor children receive adequate dental care. We have a pretty good idea of what we need to do, from a medical and policy standpoint, to eliminate these obstacles. And there are models for effective dental care delivery systems for low-income children." In spite of this knowledge, the system remains broken. Laurie made specific proposals to the Congress and to the Centers for Medicaid and Medicare Services (the federal agency which administers Medicare, Medicaid, and the State Children's Health Insurance Program) on the need to establish better performance measures and to enforce the current programs. An article about the testimony in the Washington Post is below. Click on this link to see the rebroadcast of a Good Morning America show featuring Deamonte's mother and Laurie Norris: http://abcnews.go.com/GMA/OnCall/story?id=3120743 Click on the screen on the upper right to see the video clip. Hearing on Md. Child's Death Explores Dearth of Dental Care By Mary Otto Washington Post Staff Writer Thursday, May 3, 2007; B01 The case of Deamonte Driver, the 12-year-old Maryland boy who died because of a dental infection, sparked a wide-ranging hearing on Capitol Hill yesterday as lawmakers delved into the difficulties the poor face in getting access to dental treatment. Rep. Dennis J. Kucinich (D-Ohio), chairman of a subcommittee looking into gaps in Medicaid coverage, had his staff call dentists on a list available to the mother of the Prince George's boy who died Feb. 25 of an infection that began with an abscessed tooth and spread to his brain. Of the 24 dentists listed as participating in United Healthcare, a managed care organization serving area Medicaid beneficiaries, none could have helped him, Kucinich said. Telephone numbers for 23 were disconnected, incorrect or belonged to a dentist who did not take Medicaid patients. The 24th was an oral surgeon. Government regulators, who depend on managed care organization data to assess the effectiveness of Medicaid, "would have believed that the number of dentists who could have served Deamonte was 24," Kucinich said. "But the real number is zero." An official from United Healthcare was quick to rebut Kucinich. In an interview, Peter Ashkenaz said: "We've got 92 dentists in Prince George's County, and in 2006 we paid claims to 78 of them. I don't know where he is pulling that from." Deamonte's death drew national attention to the problems of those without access to dental care, prompting calls for change. Sen. Benjamin L. Cardin (D-Md.) has co-sponsored a bill that would provide millions in federal dollars to increase dental care for the poor. A large photo of the boy gazed down from two large screens, as his story was interwoven throughout much of the hearing. "With all the resources available to us, how did we so thoroughly fail this little boy?" asked Rep. Elijah E. Cummings (D-Md.). In Maryland, a survey of more than 700 dentists listed as Medicaid providers found 170 who said they would take a new Medicaid patient, said Norman Tinanoff, chairman of the Department of Pediatric Dentistry at the University of Maryland Dental School. Prince George's County has 45,000 to 50,000 child Medicaid participants, yet only about 50 dentists on a list provided by the county health department will see them, Temple Hills dentist Frederick Clark said. "With this disproportionate ratio of patients to providers, it is virtually impossible for a parent to find a dentist to treat their child's dental concerns," Clark said. At the time Deamonte fell ill, his family's Medicaid coverage had lapsed. Yet even on Medicaid, his mother, Alyce Driver, said her children lacked regular dental care and she had great difficulty finding a dentist. It took seven months of effort for her to get treatment for a younger son whose dental problems had originally seemed more pronounced than Deamonte's. The treatments came only after the mother reached out for help, said Laurie Norris, a lawyer from the Baltimore-based Public Justice Center, who testified at the hearing. "It took the combined efforts of one mother, one lawyer, one help-line supervisor and three health-care case management professionals for a single Medicaid-insured child," Norris said. The state's Medicaid reimbursement rates, which ranked lowest in the nation in 2004 for restorative procedures, are a deterrent for some dentists, Tinanoff said. "An illustration of the problem is the current reimbursement rate for dental sealants," he said. Maryland Medicaid pays $9 per sealant, a fraction of the going rate. Burdensome paperwork and the level of need presented by poor families also discourage dentists, Clark said. Despite recent efforts to change the system, fewer than one in three children in Maryland's Medicaid program received dental service in 2005, the latest year for which figures are available from the federal Centers for Medicare and Medicaid Services. Specialty procedures -- including fillings, extractions and surgery -- are particularly hard to obtain. A 2004 study cited at the hearing found that fewer than one in five Medicaid-covered children nationally had received a single dental visit in the previous year.

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