Democrats to Push Medicaid for Children

Democrats in Congress are putting a new emphasis on enforcing Medicaid laws, and the first target is dental care for children. The action follows the death of a 12-year-old Maryland boy from untreated tooth decay.

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Democrats who control Congress have not been able to change much about the health care system. So now, instead of trying to change the law, they are trying to enforce laws that already exist. Their latest target is Medicaid. Among other things, that health program is supposed to guarantee dental care for America's poorest children. But in many states that's just not happening.

Here's NPR's Julie Rovner.

JULIE ROVNER: On February 25th, 12-year-old Deamonte Driver of Clinton, Maryland, a long-time Medicaid recipient, died of untreated tooth decay, literally.

Representative DENNIS KUCINICH (Democrat, Ohio): By the time Deamonte received any care for his tooth, the abscess had spread to his brain. And after six weeks and two operations, Deamonte died.

ROVNER: That was Ohio Democratic Congressman Dennis Kucinich at a hearing last week of a subcommittee of the House Oversight and Government Reform Committee. Laurie Norris is a lawyer who'd been trying to help the Driver family find a dentist for Deamonte's younger brother, DaShawn. His teeth were even worse than Deamonte's. Because so few dentists in their county accept children on Medicaid patients, it wasn't easy, Norris said.

Ms. LAURIE NORRIS (Attorney, Public Justice Center): It took one mother, one lawyer, one helpline supervisor and three case-management professionals to make a dental appointment for one Medicaid child.

ROVNER: In fact, statistics show that nationwide only about one of every three children on Medicaid actually gets in to see a dentist each year, and it's not for lack of trying. Dentists say that what Medicaid pays per patient doesn't even cover the cost of a visit. The result is that in every state there are too few dentists taking Medicaid patient to meet the demand.

Dennis Smith, who oversees the Medicaid Program for the federal government, told the subcommittee he knows that there's a shortage of dentists available to children on Medicaid, but he insisted the problem is the state's fault.

Mr. DENNIS SMITH (Director, Center for Medicaid and State Operations): States control the reimbursement rates. It's the states who set how much they will pay their providers.

ROVNER: That's technically true but shifting the blame to the states didn't go over well with lawmakers, even Republicans like Connecticut's Christopher Shays.

Representative CHRISTOPHER SHAYS (Republican, Connecticut): You could have come and said we need a plan to deal with that. I mean, I would think you would be advocating states to fund this system better.

ROVNER: And California Democrat Henry Waxman argued that if states aren't paying dentists enough to make sure all children get care, then Smith isn't doing his job. Medicaid is jointly funded by state and federal dollars, but in order to get those federal dollars, Waxman said, states are supposed to provide dental care to children.

Representative HENRY WAXMAN (Democrat, California): Have you ever asked the state to increase their reimbursement levels? Have you ever told them they're breaking the law by not providing a sufficient reimbursement level to provide the care for those people who are eligible?

ROVNER: Smith said no, because his only real enforcement option would be to withhold all of the state's federal Medicaid funding. He said he has been trying other fixes.

Mr. SMITH: I think we have done a number of things to help states improve the quality of care for Medicaid children.

Rep. WAXMAN: Such as?

Mr. SMITH: Well, one thing that we did in direct outreach to individuals again, you know, patient awareness and education.

ROVNER: But that didn't satisfy Waxman, either. If a parent knows their children are eligible for the benefit but can't find a dentist, he said, what are they supposed to do?

Rep: WAXMAN: Should they call a congressman and say pass a law to require that we get these services? Congressmen would say yes, that's right. But we already have a law. What protection is a law if it's not giving them the benefits?

ROVNER: Whether or not Smith will now lean harder on states is unclear, but what is clear, says Sara Rosenbaum, a professor of health policy at George Washington University, is that in a program as big and complicated as Medicaid, lawmakers must continue to pay attention to whether patients are getting the services Congress intended.

Professor SARA ROSENBAUM (Health Policy, George Washington University): In Medicaid, oversight of current program operations may be far more important than changing the law.

ROVNER: And there's more oversight of Medicaid to come. Today, Rosenbaum is releasing a study that shows the way the Bush administration is interpreting a law designed to keep illegal immigrants off the Medicaid roles is actually preventing coverage for citizens as well. Get ready for another hearing.

Julie Rovner, NPR News, Washington.

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