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Boy's death of untreated dental decay puts spotlight on gaps in medical aid

WASHINGTON - Earlier this year, the death of a local boy from untreated dental decay shed a grim spotlight on gaps in federal and state medical assistance programs charged with providing care to 30 million poor children.

Deamonte Driver, 12, gave a face to the two-thirds of Medicaid children who receive no dental care, and his name became a rallying cry for a multitude of reform efforts now unfolding.

A congressional inquest that began in May with lawmakers angrily interrogating federal health officials and insurance executives continues to probe failings in the system. This month, members of Congress will push ahead with a bill that would strengthen dental care for the children of the working poor. Officials in Maryland, where Deamonte lived, will consider recommendations for a major overhaul of the state's Medicaid dental program that serves nearly 500,000 poor children.

"In letters and speeches, we all mention Deamonte Driver," said Representative Elijah Cummings, a Maryland Democrat. "We want to keep the memory of this boy alive. We want to make sure that life comes out of his death."

Maryland's eight-member Democratic congressional delegation says it plans to fight to get a guaranteed dental benefit included in the reauthorization of the State Children's Health Insurance Program, or S-CHIP, a decade-old federal-state program set to expire Sept. 30.

The dental guarantee and several other related provisions are in a House version of a bill that must be reconciled with a Senate version. The Senate does not include the dental guarantee but does have an amendment, sponsored by Senator Benjamin Cardin, a Maryland Democrat, that would authorize $200 million in grants to states to improve dental care for children. The entire bill, however, remains under a veto threat from President Bush.

Another bill awaiting approval, sponsored by Representative Albert Wynn, a Maryland Democrat, would provide tax credits for dentists serving the poor and $3 million annually for four years for outreach projects in areas with few dentists.

And Cummings is sponsoring a measure that would authorize $10 million annually for four years to support the hiring and training of dentists serving poor communities.

He is calling it Deamonte's Law, he said, because the tragedy struck a personal chord for him.

"As a young boy, I grew up in a very poor family. . . . This story brought back a lot of painful memories," Cummings said. "I used to think toothaches were just a part of living."

Cummings and other members of a congressional subcommittee also are continuing to press for answers about shortcomings in federal and state management of the Medicaid program. At a May hearing, the panel probed the barriers Deamonte's mother, Alyce Driver, faced in obtaining dental care for her children in the months before Deamonte died after an infection from an abscessed tooth spread to his brain.

"Federal law requires these services be made to children," Representative Henry Waxman, a California Democrat and chairman of the committee on oversight and reform, said as he angrily questioned a Medicaid official. "You're not doing a good enough job if two out of three kids do not get pediatric dental care and they are eligible for it.

"Don't you have any responsibility for this? Do you have a suggestion for changing the law? Is there any reason you're not enforcing the law?" Waxman asked.

Dennis Smith, director of the federal Center for Medicaid and State Operations, said it was the states' responsibility to meet the requirements.

Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services, said that the center is "working on a response to the questions" from the subcommittee.

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