Many children with Medicaid not getting required dental care

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CHICAGO — Three out of four children covered by Medicaid in four states didn’t receive all required dental care over a recent two-year period, according to a federal report that recommends a government push to improve access to care.

One in four such kids didn’t see a dentist at all, the Health and Human Services inspector general’s office said Monday. Among the reasons were that there were too few dentists accepting Medicaid patients and a lack of education about the importance of proper dental care.

In 2007, 12-year-old Deamonte Driver of Maryland died from an infection that started in an abscessed tooth, turning national attention to a longstanding economic disparity in children’s oral health. Monday’s report sends a message that the problem still exists.

Investigators looked at Medicaid dental claims for 2011 and 2012 in four states: California, Indiana, Louisiana and Maryland. The states serve about one-fifth of all children with Medicaidand are thought to be representative of the nation as a whole.

Problems haven’t improved with more coverage under President Barack Obama’s health overhaul, experts said. The Affordable Care Act’s insurance expansion, which began in 2014, has only meant there are more families competing for the limited number of dentists participating in Medicaid, said Meridith Seife, a deputy regional inspector general who worked on the report.

“We found a significant number of children, 28 percent, who didn’t receive any dental services over a two-year period” despite being continuously enrolled in Medicaid, Seife said. “We found that to be a huge, huge problem.”

Medicaid covers dental care for an estimated 37 million children from low-income families. The state and federal Medicaid program varies by state, but there are national shortages of dentists who participate.

Medicaid pays about half what commercial insurance pays for pediatric dental services, according to the most recent survey by the American Dental Association, which says more dentists participate in the program when rates increase.

In 2013, the American Dental Association found that 48 percent of children with Medicaid had seen a dentist in the past year, compared to 64 percent of children with private insurance. That was a smaller gap than in 2005, when 35 percent of children with Medicaid and 60 percent of privately insured children had an annual dental checkup.

A lack of dental care can lead to infections that require emergency room visits and expensive repairs.

In New York, Dr. Amr Moursi recalled treating a 3-year-old patient, a girl whose baby teeth were so severely decayed and infected that he had to remove all 20 of them in an expensive surgery under full anesthesia. It’s an extreme example of how constant snacking and sipping from a bottle or cup can bathe a child’s mouth in bacteria-feeding carbohydrates, Moursi said. The girl, now 7, is doing well, her adult teeth healthy thanks to regular preventive care.

“We need to get children who are enrolled and eligible for services to actually get them,” said Moursi of New York University College of Dentistry, who was not involved in producing the report. He also is a national spokesman for the American Academy of Pediatric Dentistry.

In the four states, the percentage of children not receiving all required dental services ranged from a low of 73 percent in Maryland to a high of 81 percent in Louisiana. In California and Indiana, 78 percent of children did not receive required dental care.

The states had adopted the American Academy of Pediatric Dentistry schedule of care, requiring exams and cleanings every six months.

But Indiana and Louisiana had coverage policies that didn’t allow Medicaid payment for particular services in the established schedule. The coverage policies “were impeding children from getting the services they need and were required to get,” Seife said.

The report recommended requiring states to create action plans and more tracking of delivered care. The Centers for Medicare and Medicaid Services agreed with most of the recommendations, but said it didn’t want to add tracking requirements to what’s already required of states.

CMS spokesman Aaron Albright said the agency is “working with states to decrease barriers and seek ways to increase the number of providers.” From 2007 to 2014, 60 percent of all states achieved at least a 10 percentage point increase in the proportion of enrolled children who received a preventive dental service during the year, Albright said.

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A healthy child has a better chance to learn: Editorial

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The strain of poverty and poor health makes it more difficult for many youngsters in Louisiana to succeed in school. Roughly 28 percent of children statewide are living in poverty. The percentage is even higher in New Orleans, where the child poverty rate is 44 percent, according to the Data Center. Although Louisiana has increased the number of children covered by Medicaid, there are still gaps in health care statewide and thousands of children are vulnerable.

Louisiana also lags behind other states in academic achievement. Strong schools are essential to changing that, of course. But it also is important to make sure that children aren’t dragged down by poor health, hunger or other hardships.

In an effort to do that, the state is adopting the holistic model developed by the Centers for Disease Control and Prevention. The Legislature last year charged the Department of Health and Hospitals, Department of Education, United Way of Southeast Louisiana, the New Orleans-based Childhood and Family Learning Foundation and others with developing a plan to implement the CDC’s Whole School, Whole Community, Whole Child program statewide.

That effort is still in the planning stage, but it got a big boost this week with a generous $250,000 donation from an anonymous donor to United Way. The money will help launch the health initiative in schools across the state, United Way president and CEO Michael Williamson said.

“Decades of research shows healthier children are better students — more able to succeed in school and in life,” the United Way said in a press release about the donation. The donation will help pay for a plan to identify health issues that affect students and coordinate care for them.

When children are dealing with health problems, they are more likely to fall behind — and perhaps more likely to drop out of school. That limits their ability to get a decent-paying job and could keep them mired in poverty.

“Given that a healthy child makes a better learner, the goal is to reduce the number of school-aged children who experience health barriers to learning and establish programs aimed at evaluating and addressing the health status and need of each child,” Mr. Williamson said.

The “whole child” model focuses on health education, nutrition, wellness, school climate, health services, counseling and social services, community involvement, family engagement and physical education, among other areas.

United Way and the Childhood and Family Learning Foundation are already working together on coordinated health care at a dozen schools in New Orleans. The plan now is to expand those efforts statewide.

Phyllis Landrieu, co-founder, president and CEO of the family learning foundation, said the effort could make a major difference in children’s lives. “A consistent and comprehensive statewide process for preventive health screenings every year for all students in all schools could assure reaching all children in need,” she said.

Improving the health of children will not only help them succeed in school now, but should improve their opportunities in the long run.

Statewide, 1-in-3 married-parent families and 4-in-5 single-mother families don’t make enough money to be economically secure, according to a January 2015 study by the Jesuit Social Research Institute at Loyola University.

Researchers looked at cost of living data to calculate the amount the average household needs to pay for essentials and live a “modest but dignified” lifestyle.

According to the study, the average income needed by a single parent in New Orleans with one child is $51,264. That figure rises with more children in a home.

Strengthening students’ ability to learn could allow those children to eventually compete for better-paying jobs — and give their families more financial security.

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