States Looking to Fill Gaps in Dental Care for Kids

STATES LOOKING TO FILL GAPS IN DENTAL CARE FOR KIDS

Volume 28, Issue 489 April 16, 2007

Matthew Gever

In March, Maryland youth Deamonte Driver died after an abscessed tooth caused an infection that spread to his brain. His story, as well as sobering national statistics, have inspired legislators to look for ways to bring dental care to those in need.

“Sadly, Deamonte represents the worst case scenario of multiple systems failures,” said Burton L. Edelstein, of the Children’s Dental Health Project.

“There is a critical need for good oral health. We are falling short,” said Iowa Representative Pam Jochum. The 2006 National Survey of Children’s Health reports that poor oral health is the most common chronic condition among children. In addition, the survey found that black and Hispanic children have worse oral health than white children. Children whose families live at or near the federal poverty level also have much worse oral health indicators than children from more financially stable families.

Making the problem worse is the fact that oral care is often considered separate from other health care for insurance purposes. As a result, many go without coverage. While more than 45 million Americans are without health insurance, at least three times as many are without dental coverage, according to the National Health Policy Forum.

Access to dental care has expanded since the enactment of the State Children’s Health Insurance Program (SCHIP) in 1997, but states still face a number of barriers. The primary problem is the shortage of dentists—especially pediatric dentists—in many rural and underserved communities. States can ameliorate this to some extent by focusing on broader preventive services such as water fluoridation and public awareness campaigns, dentist recruitment programs and expansion of dental benefits in SCHIP.

Experts repeat the mantra that preventive care is more cost-effective than urgent care. “Rather than a quarter million dollar bill to Maryland Medicaid for neurosurgery, he [Driver] could have been treated with a sealant, a filling, or if necessary an extraction—any one of which would cost the state less than $150,” said Edelstein.

Michigan is one state that has taken substantial steps to improve access. In 2000, the state began the Healthy Kids Dental program, a partnership between the state’s Medicaid program and Delta Dental of Michigan. The program operates in 59 of Michigan’s 83 counties, the majority of which are rural and designated as dental health professional shortage areas. Since the program works with Delta Dental, recipients have access to Delta dentists, who are reimbursed by Medicaid but at the Delta rate. Additionally, participants receive a Delta card, which removes the stigma of public assistance.

Studies have shown that dental visits are 50 percent higher for kids in the program than for those in traditional Medicaid, with 92 percent of participants indicating that their children’s health has improved since enrollment. Additionally, travel times have been cut in half for beneficiaries.

Mobile Vans and Other Approaches

Other states are considering other means to expand access. Driver’s home state of Maryland is sending SB 181 to the Governor. The bill would set aside $2 million a year over the next three years to expand public clinics in underserved areas.

In Iowa, Representative Jochum is sponsoring HF 61, which would create a mobile dental health program for on-site dental care. The program is targeted to at-risk and special-needs populations such as rural, underserved, elderly, youth and racial or ethnic minority populations.

“Few dentists in Iowa take Medicaid patients. And private health insurance provides minimal dental coverage for many Iowans,” said Representative Jochum. A separate fund would be created out of general department revenues to fund the program, which the Department of Public Health would administer. The bill also establishes a dentist recruitment program, which would offer loan forgiveness to dental students who agree to serve in an underserved area after graduation.

A similar bill has been introduced in New Mexico. HM 59 would require the Department of Health to conduct a study on mobile dental health clinics in the state, examining the feasibility of such a program and determining which areas of the state would benefit most.

Montana Representative Bill Jones has introduced two bills which seek to address access to dental care for uninsured children. HB 198, which the Governor signed into law on April 10, appropriates funds to expand dental benefits under SCHIP. HB 394 would make funds available to provide dental care to underinsured children who would not otherwise be eligible for Medicaid or SCHIP. Jones noted that while many children in the state have healthy teeth, a small number have significant and costly dental problems. “I think this is an issue that will get bigger and bigger,” he added.

In Texas, Representative Garnet Coleman introduced HB 2683, which seeks to expand access to health and dental care across the state. Among other things, the bill would encourage the Texas Higher Education Coordinating Board to encourage dental and other health-care providers to practice in underserved areas of the state, primarily through loan forgiveness programs. “It is unacceptable to not fully commit to the health of our children,” said Representative Coleman.

On the Federal side, U.S. Representative John Dingell of Michigan has introduced HR 1781, which would expand dental health services through Medicaid and SCHIP. The bill would provide funding to states to recruit dentists to underserved areas and allow states to use SCHIP to supplement dental coverage for kids with private health insurance. “Dental disease is the most common childhood disease—more prevalent than asthma, diabetes and hay fever. It is also the easiest to prevent,” said Congressman Dingell in a statement.

© Copyright 2007, State Health Notes