January 30th, 2009
The tragic death of a 12-year-old Maryland boy, whose untreated tooth infection had spread to his brain, has spurred Congress to mandate that all states provide dental services as a benefit in their State Children’s Health Insurance Program (SCHIP).
The death of Deamonte Driver on February 25, 2007, shone a spotlight on the difficulties poor families have in gaining access to a dentist. The Driver family, like many other families of modest means across the country, lack dental insurance. Dental cavities are “the most common chronic disease of childhood” and are closely linked to socioeconomic status and ethnicity.
At one point, Deamonte’s family had Medicaid coverage, but they lost it because they had moved into a temporary shelter, and their paperwork fell through the cracks. When advocates for the family tried to help, it took more than 20 calls to find a dentist who would treat him. Medicaid payments to dentists, like those of physicians, are far below what private insurers pay for the services of these providers.
About six weeks before he died, Deamonte began to complain of a headache. An evaluation at Children’s Hospital in the District of Columbia determined that bacteria from a tooth abscess had spread to his brain, requiring physicians to perform emergency surgery. He later experienced seizures, and a second operation was performed. But the medical interventions failed to save Deamonte, and he passed away on February 25.
Deamonte’s death was widely publicized in the Washington Post and other media outlets throughout the nation. The publicity caught the attention of members of Congress and state legislators as well. It prompted Democratic Senators Benjamin Cardin of Maryland and Jeff Bingaman of New Mexico to introduce legislation designed to provide dental coverage to children in low-income families that lack coverage.
Cardin said: “It is outrageous today that in America a young boy can die because his family can’t find a dentist to remove an infected tooth. Any time we lose a child, it is a tragedy. But Deamonte Driver’s death is particularly devastating because it was easily preventable.” At the first anniversary of Deamonte’s death, Cardin issued a news release, which said in part: “At the end, the total cost of his treatment exceeded a quarter of a million dollars — more than three thousand times the $80 it would have cost for a tooth extraction.”
Now, some two years later, reauthorization of SCHIP is well under way in Congress, strongly backed by Democrats and President Barack Obama. The House approved a measure reauthorizing SCHIP by a vote of 289 to 139 on January 14, and a very similar Senate measure was approved 66-32 on January 29. Both measures require states to expand their SCHIP benefits to include dental services. The Senate bill also includes a provision championed by Senator Bingaman that would enable children of low-income families who have private insurance to receive dental coverage as a “wrap-around” benefit paid for by SCHIP.
Under the House and Senate measures, states would have the option of providing dental services through benefit packages modeled after one of several benchmark plans. These plans include the Federal Employes Health Benefit (FEHB) program, insurance plans offered to state employees, and commercial health maintenance organizations (HMOs). These bills require states through their SCHIP programs to provide information on dentists through the federal Insure Kids Now Web site and hotline.
Under these bills, the Government Accountability Office would conduct a study on children’s access to dental care under Medicaid and SCHIP. The report would include recommendations for how federal and state governments could address barriers to dental care, and the feasibility of using qualified mid-level providers to improve access.Email This Post Print This Post
Don't miss the insightful policy recommendations and thought-provoking research findings published in Health Affairs.