1. The Death of Deamonte Driver: Out of Tragedy, A Light to Shine on the Mouths of Maryland Children
The Kaiser Commission on Medicaid and the Uninsured
Alliance for Health Reform Briefing
Washington, DC
July 25, 2008
Dr. Harry Goodman, Director
Office of Oral Health
Maryland Department of Health and Mental Hygiene

2. Deamonte Driver
Grew up in Prince George’s County, Maryland, the 3rd of 5 boys
From low-income family
Children had medical and dental insurance through the Maryland HealthChoice (Medicaid) program contracted thru managed care organizations (MCO)
Had long-standing tooth decay and abscess – but never complained
Always received primary medical care through a pediatrician – a medical home
But not a dental home – no primary care dentist
Mother could not find a dentist willing to accept Medicaid despite the Medicaid MCO listing 27 dentists on their provider panel for that area
All panel dentists could not see his brother
Needed the Public Justice Center along with the help of others to finally find a dentist to treat his brother

3. Deamonte Driver’s Maryland
1990’s – Ranked last by the ADA for Medicaid dental access
No dental rate increases since the 1970’s
Many dentists stopped participating in Medicaid for various reasons
HealthChoice – 7 MCOs with 3 dental subcontractors
1998:
Office of Oral Health established in statute
A major state legislative bill targeting Medicaid dental access passed
% Head Start children with untreated tooth decay
% schoolchildren with untreated tooth decay
2003 – Medicaid dental rates for 11 procedures increased
2006 (most recent data):
29% of Medicaid enrolled children had at least one dental visit
16% of all provided dental services were for restorative (fillings) care
19% of dentists participated in Medicaid
7% billed $10,000 or more
Very few pediatric dentists

4. Deamonte Driver’s Maryland
By February 2007 (just prior to Deamonte’s death):
Most Medicaid fees paid at below the ADA 25th percentile and many below the 10th percentile
12 of 24 local health departments with clinical dental services
10 of 16 federally qualified health centers with clinical dental services - most located in Baltimore City
Dental hygienists unable to practice in public health settings without a dentist present and a dentist seeing a patient first
Physicians not routinely involved in oral health assessments
Dentist and dental hygienist workforce issues – maldistribution
More acute situation for specialists – pediatric dentists
Recruitment and retention problems – public dental programs

5. Deamonte Driver Deamonte never complained and no one was looking
Mid-January 2007, had severe headaches
Pediatrician found tooth decay upon an oral exam
Diagnosed first as a sinus infection and then a brain infection
Underwent 2 brain surgeries, experienced seizures, had 1 tooth extracted, and spent 6 weeks in a hospital
Emergency treatment cost = $250,000
Medicaid cost of simple extraction - <$100
Medicaid cost of preventive services - <$60 - $80/year

6. Tragedy Died unexpectedly on February 25, 2007
Cause of death listed as meningoencephalitis and subdural empyema
He was failed on the front end (lack of timely diagnostic and preventive dental care) and on the back end (lack of access to dental treatment)
Laurie Norris, Esq. of the Public Justice Center called him the “canary in the coal mine”

7. The Legacy of Deamonte Driver: A Light Begins to Shine in Maryland
June 2007:
Dental Action Committee (DAC) convened by John Colmers, Secretary, Maryland Department of Health and Mental Hygiene
September 2007
DAC Report issued
7 main recommendations (60+ in all)
October All recommendations supported by Secretary Colmers
January 2008 – all funding recommendations in Governor Martin O’Malley’s FY 09 budget whose support was critical
Medicaid dental rates increase ($14M/each for 3 years)
Enhancement of dental public health infrastructure ($2M/year)
April 2008 – Governor’s oral health budget initiatives and other related bills passed by the Maryland General Assembly and signed into law by the Governor
Tremendous support from our Maryland federal and state legislators

8. Dental Action Committee 7 Main Recommendations
Increase dental reimbursement rates (indexed by inflation) to median fee charged by area dentists (ADA 50th percentile) – began July 1, 2008
First of 3 annual increments – most diagnostic and all preventive rates increased
Single payer dental Medicaid program – carve out from Medicaid program
RFP issued June 2008/Target implementation date – July 2009
Increase the dental public health infrastructure - $2M/yr.
Funding to Office of Oral Health beginning July 2008
Expand the role of dental hygienists in public health practice
Legislation (HB 1280/SB 818) unanimously passed/Takes effect October 2008
Pediatric dental training of physicians and general dentists
April 2008 – 150 trained at the University of Maryland Dental School
Fluoride varnish initiatives - Medicaid reimbursement to physicians in July 2009
Oral health screenings required for school entrance
Projected demonstration project 2009 school year
Legislation in 2010 state legislative session
Develop a unified educational/social marketing program
Will need federal funding ($2-3M)
University of MD Dental School – CDC grant request:
Deamonte Driver Program of Oral Health Access - $1.1M

9. Federal Assistance to the States
Funding to increase public awareness of oral health, specifically disease prevention and management
Funding to develop specific social marketing campaigns to educate and recruit health care practitioners (dentists and physicians) regarding Medicaid dental coverage and services
Include education to treat very young children and related incentives
Support for:
SCHIP Reauthorization:
A guaranteed dental benefit for SCHIP eligible children
Informing new parents about cavity prevention
Expanding public/private partnerships by allowing community health centers to contract with private dentists to provide services
The CHAMP Act
Deamonte’s Law (H.R – Maryland Congressman Cummings)
Elements of the Essential Oral Health Care Act (H.R – former Maryland Congressman Wynn)
Increase the FMAP so that the federal government would pay 100% of the differential needed to move dental payment rates to between 70-80% of full commercial rates
S. 739 (Senator Bingaman – 2007) - A bill to provide disadvantaged children with access to dental services
Upcoming legislative bill – Oral Health care for All Americans Act (Senator Bingaman)

10. Final Thoughts
Reference – Dental Action Committee Report
Thanks to Governor O’Malley and Secretary Colmers for their leadership and support
Thanks to our effective advocacy partnership with many key supporters, such as our Maryland Congressional offices (such as Senator Cardin and Congressman Cummings and their staff), State legislative leaders (such as State Senator Mac Middleton and Delegate Peter Hammen) and many other entities representing the welfare of children and youth
“We can easily forgive a child who is afraid of the dark, the real tragedy of life is when men are afraid of the light." Plato