Will a Child’s Death Change Dental Policy?
December 7th, 2008
State health officials say dental care is the No. 1 unmet health care need for kids, low-income adults.
By Anthony Gottschlich
DAYTON — When 12-year-old Deamonte Driver of Maryland died last year following an untreated toothache, it put the public on notice for what health experts already knew: Dental health is a critical component of overall health, but if you’re a child from a poor family, good luck getting it.
That’s the story across much of the nation, including in Ohio, where dental care is the No. 1 unmet health care need for children and low-income adults, according to the Ohio Department of Health.
Dentists and health experts lay most of the blame on Medicaid, saying the state-federal health insurance program for the poor and disabled pays only about half of what dentists charge for their work and not enough to cover expenses.
That’s despite federal Medicaid law that requires states to “assure that payments are … sufficient to enlist enough providers so that care and services are available” to Medicaid recipients to the same extent they’re available to the general population.
“It doesn’t make sense,” said Dr. Gordon Womack, medical director of Dayton Pediatric Dentistry at Children’s Medical Center of Dayton. “(As a Medicaid provider) I’m really a government contractor, but there’s not another government contractor out there who’s going to cut his fees half-price.”
“It’s not like it ought to be, (not) anywhere close,” Womack said. “It’s just an ongoing battle to get these children care.”
“Serious public health problem”
Tooth decay is the nation’s most common chronic childhood disease, according to the Centers for Disease Control and Prevention. It leads to problems with eating, speaking and the ability to learn, as well as pain, poor self-esteem and more than 51 million missed school hours each year, according to the U.S. Surgeon General.
In Ohio, more than one-fourth of all third-graders had untreated tooth decay in 2007, according to a survey conducted by the state health department. Nearly a fourth of the state’s children, or 633,000, lacked dental insurance, and 15 percent had never been to a dentist, a 217 percent increase over 2002.
In Montgomery County, 20,000 children last year had never been to a dentist and nearly 28,000 didn’t have dental insurance.
That worries Womack and other dentists, who say untreated tooth decay can lead to more serious infections that require costlier care, often in emergency rooms and at taxpayers’ expense.
In Deamonte Driver’s case, the youth’s tooth decay progressed to a brain infection after his mother couldn’t find a primary care dentist willing to accept his Maryland Medicaid plan. Two brain surgeries later, he died.
His emergency treatment cost $250,000, according to the Maryland health department. Treating his toothache would have cost less than $100.
“It’s a serious public health problem,” said Dr. Paul Casamassimo, professor of pediatric dentistry at Ohio State University and a spokesman for the American Academy of Pediatric Dentists. “Until the Medicaid reimbursement rates begin to approach that of what dentists can make in private practice with an insured or cash-patient population, things will not get better, things will not change.”
Funding challenge
The federal standard requiring adequate Medicaid reimbursement has generally not been followed, nor enforced, the Kaiser Commission on Medicaid and the Uninsured noted in a report it released this year, “Filling an Urgent need: Improving Children’s Access to Dental Care in Medicaid and S-CHIP,” the federal-state children’s health insurance program.
In Texas, it took a class action lawsuit filed on behalf of Texas mothers to get the state to increase reimbursement rates and improve access to preventive care for children. The suit took 14 years before reaching a settlement last year. Other states have taken similar actions, but not Ohio.
“We have been battling to improve the dental Medicaid program for a long time,” said David Owsiany, executive director of the Ohio Dental Association. “I understand the difficulties the General Assembly and the governor face with a very tight budget and an economy that is struggling, but the flip side of that is not covering dental care (with adequate funding) is penny-wise and a pound foolish.”
Raising Medicaid reimbursement rates, however, is never easy, especially amid tough economic times and rising Medicaid enrollment, said John Corlett, Ohio’s Medicaid director.
“Ohio’s Medicaid case load has been increasing since June 2007 and it continues to exceed the budgeted estimate,” Corlett said. “Over the last year, we added 73,000 people — 37,000 more than projected.”
Medicaid covers around 2 million Ohians and consumes the biggest chunk of the state’s budget, more than $11 billion per year. About $122 million of that was spent on dental care in 2006, according to the Ohio Department of Job and Family Services.
Still, Corlett said, the state is striving to improve preventive care and encourage more dentists to participate in Medicaid. The state has simplified dental claim forms, and on July 1 this year it reinstituted full dental coverage for adults enrolled in Medicaid, a benefit Gov. Bob Taft reduced in 2006.
The state also raised reimbursement rates for several dental procedures, though just a modest 2 percent — $54 for a two-surface filling, for example, up from $52.92.
Michigan plan
Owsiany, the dental association director, said Ohio should provide reimbursements more consistent with private insurance plans. He pointed to a Michigan plan that does just that.
The Healthy Kids Dental program started as pilot project in 2001 but now covers 280,000 children in Michigan, according to the Michigan Department of Community Health. Administered by a third party, Delta Dental, the Medicaid program is run like a private plan. There’s less cumbersome paperwork and reimbursement rates are up to 80 percent of the average dentist’s fees.
Dentist participation has climbed 300 percent in treating Medicaid beneficiaries; travel time for patients has been cut in half, and there are fewer missed appointments, according to the American Dental Association and Michigan health department.
As for dental visits, they were 50 percent higher last year for children enrolled in Healthy Kids compared with children enrolled in the state’s traditional Medicaid dental plan.
It’s not cheap. The program covers rural counties, mostly, at a cost of $55 million a year to the state and federal government. To cover the entire state, including urban areas where services are most needed, the cost would jump to $170 million, state officials said.
Legislative efforts
Owsiany said Ohio House Bill 456 would create a pilot program in Ohio similar to Michigan’s Healthy Kids. The bill hasn’t moved out of committee since its introduction in January.
On the federal level, U.S. Sen. Sherrod Brown, D-Ohio, is co-sponsor of a bill aimed at preventing another Deamonte Driver tragedy.
The bill would seek to establish a “dental home” for every child by increasing dental services in community health centers, training more individuals in pediatric dentistry and offering tax incentives for dentists to treat children with Medicaid.
“It’s pretty sad things have to get to that level before anybody pays attention to the issue,” said Dr. James J. Crall, a California dentist and spokesman for the American Association of Pediatric Dentists who testified this year before Congress on the issue. “We’ve got hundreds of kids, if not thousands, showing up in ERs just waiting to be the next Deamonte somewhere.”
Contact this reporter at (937) 225-7408 or agottschlich@DaytonDailyNews.com.
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