PROJECT OVERVIEW
Tragedy and Policy Change: Expanding Access to Oral Health Care for Children in Maryland
Highlights
In the 1990s, Maryland was ranked as one of the worst states for pediatric oral health, due in part to poor access to oral health services for children with low incomes. For Medicaid-eligible families, lack of providers was coupled with the administrative burdens of acquiring and maintaining benefits.
While Maryland legislators had made incremental efforts to improve dental care in the 90s, progress stalled and significant barriers remained. In 2007, these challenges received national attention when 12-year-old Deamonte Driver died from an untreated tooth abscess.
Deamonte’s death prompted policy changes that addressed barriers in access to oral care, including increased Medicaid reimbursement rates and programs to incentivize providers to accept Medicaid patients. These reforms led to significant improvements in pediatric dental care access, making Maryland a national leader in children's oral health.
In 2007, a 12-year-old named Deamonte Driver died in Maryland from an untreated tooth abscess. In Maryland, Medicaid covers dental procedures, however, prior to his death, his family struggled both with accessing and maintaining healthcare coverage, and navigating a landscape of managed care contractors and dental subcontractors. These struggles persisted despite the substantial efforts Deamonte’s mother made to access care: seeking out help from an attorney and case manager.
Deamonte’s death received national attention (see Figure 1) and exposed critical deficiencies in the state's public health system. Maryland legislators responded by launching a series of reforms aimed at dismantling the administrative and systemic barriers to oral health care, which existed for both enrollees and health care providers (see Table 1 and Table 2 for a list of administrative burdens). Reforms included funding for oral health programs, expanding care providers through establishing the role of Public Health Dental Hygienist, moving from managed care to a single vendor, and expanding the services reimbursed by Medicaid.
As a result of these efforts, Maryland became a leader in the nation for pediatric oral health, with substantial increases in Medicaid dental visits for children (see Figure 2) and improved participation rates among dentists. The changes not only marked significant progress but also earned Maryland recognition as a leader in addressing pediatric oral health needs.
On a national level, the use of oral health service has been gradually increasing since Deamonte’s death in 2007, however, less than half of children with Medicaid coverage received a preventive dental service in 2018. This rate varies substantially between states, ranging from 18 percent in North Dakota to 68 percent in Texas. Understanding how states can expand access is therefore substantively important.