Oversight Adequacy of the Pediatric Dental Program for Medicaid Eligible Children

On February 25, 2007, 12-year-old Deamonte Driver died of a brain infection that started with an untreated toothache. Standard dentistry at any point along the trajectory from cavity to root canal to abscess could have saved his life and the state of Maryland nearly $250,000. Deamonte’s death demonstrates the critical importance of oral health to children’s welfare and the barriers to accessing dental care have fatal and costly consequences.

A severe gap exists between the number of Medicaid eligible children and the provision of dental care to poor children. Although Medicaid policy, specifically Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT), addresses the issues of access to dental care amongst poor children, in a 2004 study, fewer than one in five Medicaid-covered children received a single dental visit. Tooth decay is the most common chronic childhood disease – five times more common than asthma and seven times more common than hay fever – and it has the most damaging affect on low-income communities.

This hearing will examine the adequacy of CMS oversight mechanisms used to evaluate the ability of Medicaid programs to ensure children’s access to dental health. Although infallible oversight will not redress the inadequacy of Medicaid administered dental care, achieving such redress is elusive without adequate oversight.