Dental Help for Poor Questioned

By Mary Otto
Washington Post Staff Writer
Thursday, October 4, 2007

Deamonte Driver, the 12-year-old Prince George's County boy who died in February of an infection caused by an abscessed tooth, was one of more than 10,780 Medicaid-eligible Maryland children who had not seen a dentist in at least four years, a congressional analysis has concluded.

An additional 22,110 poor children had not received dental care in at least two years, according to a review of dental records requested from United Healthcare, a managed-care organization serving Maryland Medicaid beneficiaries. The congressional subcommittee requested billing and service records from United as part of an investigation into gaps in Medicaid care for poor children.

The analysts also found that seven dentists in Prince George's County were providing more than half the care to the county's 45,000 to 50,000 child Medicaid beneficiaries. Of those seven dentists, three in a single practice provided more than one-third of the services to beneficiaries of United Healthcare. Other dentists listed in the company's network provided few or no Medicaid services to children in the county, according to the analysis.

Statewide, Medicaid serves nearly 500,000 poor children through seven managed-care organizations, including United Healthcare.

The findings are contained in an Oct. 2 letter signed by Rep. Dennis J. Kucinich (D-Ohio), the House Government Reform domestic policy subcommittee chairman, and Rep. Elijah E. Cummings (D-Md.), a panel member, and sent to state health officials and to United Healthcare.

"The death of Deamonte Driver opened up questions about what kind of care is available to children. What we are finding is that children are not getting the care they are entitled to," Kucinich said in an interview yesterday.

But a United Healthcare spokesman sharply rebutted the findings.

"We have some serious questions about some of the material in the committee's letter, and we disagree strongly with some of the conclusions," said Steven Matthews, a spokesman for United Healthcare's Medicaid health plan.

He said the company was preparing a detailed response that will be submitted to the subcommittee before an Oct. 19 deadline. United Healthcare has recently focused its efforts on improving access to care for the state's poor children, he said, by creating an updated online dental directory, providing improved customer service, adding 35 dentists to the Maryland network and establishing a dental safety net clinic at the University of Maryland Dental School in Baltimore.

Maryland's Medicaid services were singled out for scrutiny after Deamonte's death, and leaders throughout the state made dental reform a rallying point.

The state's eight-member Democratic congressional delegation fought to get a guaranteed dental benefit included in the reauthorization of the State Children's Health Insurance Program, which covers millions of children from working poor families with incomes too high to get Medicaid. Yesterday, the bill, which would have added $35 million over five years to extend coverage to 4 million children, was vetoed by President Bush, who said it was too costly.

Cummings said yesterday that he and others would continue to work to pass the bill with the dental guarantee.

Fewer than one in three children in the state's Medicaid program received any care in 2005, the latest year for which figures were available. Many dentists have declined to participate, citing bureaucratic hurdles, the difficulties of serving poor families and the state's historically low Medicaid reimbursement rates for dental procedures.

In Deamonte's case, the systemic problems were compounded by personal obstacles including a lack of transportation, erratic telephone and mail service and periods of homelessness.

His Medicaid coverage had temporarily lapsed at the time he was hospitalized after bacteria from a dental infection spread to his brain. He died after two operations and six weeks of hospital care that cost more than $250,000.

Last month, a panel of experts convened by state Health and Mental Hygiene Secretary John M. Colmers recommended restructuring the state's Medicaid program by replacing the system of managed-care organizations and dental vendors with an administrative service organization that would be in charge of all Medicaid dental care for children and pregnant women and work directly under a contract with the state. The experts also called for spending $40 million more a year to raise reimbursement rates for dentists.

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