By Mary Otto
Washington Post Staff Writer
Friday, February 15, 2008

In the year since a Prince George's County boy died of a dental infection, lawmakers say Maryland has begun addressing the structural problems and funding shortages that are blamed for breakdowns in the state's Medicaid system.

At a congressional hearing yesterday, Maryland officials won praise for initiating changes in the troubled program, which in recent years provided dental services to fewer than one-third of the 500,000 poor children statewide entitled to care.

"The new administration . . . under Governor Martin O'Malley had laudably taken the initiative," said Rep. Dennis J. Kucinich (D-Ohio), chairman of a subcommittee that has investigated the failings of the system nationwide since the death of 12-year-old Deamonte Driver last February.

"Maryland's Medicaid administration has taken a number of significant actions," said Kucinich, who called for more pressure by federal officials to push for reforms in other states.

O'Malley's proposed budget calls for spending $14 million more in state and federal funds for each of the coming three years to raise reimbursement rates to dentists treating Medicaid children. In addition, the governor has earmarked more than $1.4 million to fund clinics expected to provide care to children in underserved areas of the Eastern Shore and Southern Maryland. And the proposal allots $700,000 to pay for a van and other equipment dedicated to school-based screening and treatment.

The challenges facing Maryland's system are typical of problems nationwide. The state has a chronic shortage of dentists willing to treat poor children and deal with Medicaid's low reimbursement rates and bureaucratic hurdles. Public health and school-based clinics are also in short supply. And efforts to reach poor families, who are not always aware of the urgency of getting care and who face barriers to finding it, have often faltered.

Maryland officials are also moving forward with a plan to dramatically restructure the state's Medicaid program. Under the plan, a single administrative service organization would be placed in charge of all Medicaid dental care for children. The organization, which would work directly under a contract with the state Department of Health and Mental Hygiene, would replace a network of subcontractors for managed-care organizations that handle dental care.

And in response to an on-site review of state Medicaid operations by federal officials late last year, state officials have agreed to require that managed care organizations regularly update dental directories provided to beneficiaries enrolled in their plans and take other steps to help them find dentists who are available to see them.

Deamonte's family was homeless and had difficulty with transportation and phone and mail service. His Medicaid coverage had temporarily lapsed at the time he became ill. He died after the dental infection spread to his brain. Yet the obstacles to care his mother experienced in finding a dentist for her children are shared by many families navigating the Medicaid system.

"We have all been affected by the death of Deamonte Driver," state health Secretary John M. Colmers wrote in a Feb. 8 letter to Kucinich and the committee. "It is my strong belief that implementing these multi-year initiatives will result in Maryland becoming a model for the country in increasing access to oral health for our children."

The measures being taken were included in the recommendations of a special Dental Action Committee that Colmers convened in the months after Deamonte's death.

Harry Goodman, a professor of pediatric dentistry at the University of Maryland and the director of the state health department's Office on Oral Health, served as co-chairman of the committee. In a phone interview, he praised the progress.

"You just never know, but everything is geared to preventing another Deamonte Driver," he said. "We're touching every base."