It’s been almost four years since the tragedy of Deamonte Driver, a twelve-year-old Maryland boy who died due to complications of an untreated abscessed tooth. His death highlighted the worst case scenario for families struggling to find dental care. Those of you who know Children’s Dental Health Project (CDHP) know that we relentlessly talk about the preventable nature of dental caries (the disease that causes cavities) and the long-term consequence to children’s health, education and employability. Deamonte’s death was a tragedy for his family and our nation – but if there was ever a positive outcome it was that his death also served as the catalyst for historic change through many reforms included in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and the Patient Care and Affordable Care Act (ACA).

This week, the Government Accountability Office (GAO) released a report on dental services in the Children’s Health insurance Program (CHIP) and Medicaid. The report, which was mandated by CHIPRA, examined dentist participation in Medicaid and CHIP as well as efforts by the Centers for Medicaid and Medicare Services (CMS) to help families find dentists near them who participate in these programs. Additionally, the report examines how mid-level dental providers have been used to improve children’s access to oral health care services. While the report highlights a number of improvements in the delivery of oral health care as a result of CHIPRA and ACA, it also underscores the dilatory pace at which improvements are being made. The efforts made by the states, health providers (dental and medical), and CMS to implement the improvements in CHIPRA and ACA should be applauded. However, we should not lose sight of the fact that Deamonte Driver’s death was not an isolated incident and there are almost certainly more children across the nation enduring similar suffering (which the GAO report seems to suggest).

• Only 36% of children in Medicaid received any dental service in 2008.
• Dentist participation in Medicaid remains incredibly low across the country – in some states, fewer than half of dentists treat children in Medicaid and CHIP.
• Finding a dentist who accepts Medicaid remains the number one barrier for children in the program seeking oral health care.
• The Insure Kids Now website has the potential to assist families find dentists, however, current problems with incomplete and inaccurate information limit the site’s ability to achieve that goal.

These “highlights” illustrate the challenge that parents face when seeking necessary care for their children, even more so for families of children with special needs and those in rural and/or underserved areas. The general lack of comprehensive data on dental services is noted more than once in the GAO report and is not insignificant. Data on services delivered through managed care is, at best, sparse. Because dental care was not required until CHIPRA, data reporting was not required (although states are now required to report starting this year). The lack of data poses a challenge not only for the evaluation of oral health care services but also for the effective maintenance of consumer resources like the Insure Kids Now website. Insure Kids Now has received updated redesign, but reliable information remains difficult for states to provide and for parents to obtain.

The GAO report does include some truly bright spots. Continued support of the Health Center Program facilitated an increase of more than 30% in the number of patients served between 2006 and 2009. Additionally, the National Health Service Corps reported a significant increase in providers serving in underserved areas. As CHIPRA and the Affordable Care Act continue to be implemented, there is much to be hopeful for during this holiday season. Both laws include significant provisions to improve children’s access to oral health care and the quality of those services with an added focus on preventing tooth decay. That being said, change cannot come soon enough for children who are currently suffering from oral disease. The GAO report notes a number of improvements in the delivery of dental care but also emphasizes that, so far, these improvements have been much too slow.

For years, advocates have been calling for the various responsible agencies to coordinate efforts to improve the oral health care delivery system, infrastructure, workforce, and overall access to care. A glimmer of federal coordination is emerging and this report should encourage every agency overseeing oral health programs to work together to integrate their efforts to fully and effectively implement CHIPRA and ACA to improve the health of children.