Despite being covered by Medicaid, Deamonte Driver lacked access to preventive dental care throughout his life – a similar reality for many children and parents in America. ABC World News with Diane Sawyer recently noted reports of parents having trouble finding dentists who accept Medicaid patients. And the few dentists who were available often had long waiting times for appointments. At the time of Deamonte’s death in 2007, just 900 of Maryland’s 4,033 dentists saw Medicaid patients and only 16 percent of children covered by Medicaid received restorative services such as fillings. Deamonte’s death changed all that.
In the wake of his death, Maryland’s Department of Health and Mental Hygiene quickly convened a Dental Action Committee, which proposed recommendations to improve access to oral health care, particularly for vulnerable children and families. They included Medicaid reforms to increase reimbursement rates, expansion of the public safety net system to raise CHIP income eligibility levels and expansion of the dental workforce.
According to Goodman, although many other states know such policy changes would improve access to oral health care, they often fail to act. Maryland’s policy changes were rooted in an unfortunate tragedy, which spurred the public outrage needed to create change.
Before Driver’s death, only a third of children covered by Medicaid received dental care; five years later, that number has climbed to 42 percent, according to the Pew Children’s Dental Health Project. This increase particularly impacts people of color who comprise more than 60 percent of the state’s Medicaid population. Maryland is now touted as having one of the best oral health systems in the country.
At a February hearing in Baltimore hosted by U.S. Rep. Elijah Cummings (D-Md.), policymakers and oral health advocates outlined the strides that the state has made in the past five years.
Pew’s Shelly Gehshan offered praise, but reminded policymakers that while the state met seven of eight benchmarks on a state-by-state “report card” Pew issued in 2011 (dental sealant programs, community water fluoridation, Medicaid reimbursement and enrollment and collection of data on children’s dental health), it still did not meet the benchmark of authorizing new dental providers to help address the dental workforce shortage. According to the Pew report, 23 states and the District of Columbia received a C or lower grade; 5 of these states received an “F” grade. And according to the Institute of Medicine, the current dental care delivery system fails to meet the needs of a third of all Americans.
And although Maryland received an “A” and was the top-performing state in the Pew ratings in 2011, more than 600,000 Marylanders still live in dental shortage areas, Gehshan said, noting that other states with workforce shortages are considering new types of dental providers to meet the need. “There is evidence to support these approaches and the Institute of Medicine recommends that states try them,” she testified.
Goodman echoed her praise, noting that Maryland has gone from having one of the worst records in oral health for underserved populations to one of the best. U.S. Public Health Service Chief Dental Officer Dr. William Bailey summarized, “Like others, I have been watching Maryland and I like what I see.”