Bush legacy: Less Dental Care for Children

While this is a Florida story, I think it has national implications as well since Jeb Bush has on a number of fronts (for instance charter schools) used Florida as a testbed for Bush administration ideas.

Anyway, a little over a year and a half ago, Florida decided to privatize dental care for children in Miami-Dade who are on Medicaid, and the early results are in.

More than a year and a half after the state started an ambitious pilot program to treat the dental needs of poor kids in Miami-Dade County, preliminary data indicates the pilot may have resulted in a dramatic reduction in treatment.

Partial data for one key indicator -- basic oral exams -- indicates that only one-third as many kids are getting them now as under the old program.

More after the flip.

So allegedly, the pediatric dental care under Medicaid was rife with waste fraud and abuse, and the answer was to give a management contract to to a Coral Gables firm, Atlantic Dental.

The brilliant plan was that since dentists were allegedly billing for unneccesary or unperformed work, instead Atlantic Dental would pay them a flat fee, regardless of whether they even see the patient.

And the results:

What is available is not encouraging. Consider two categories, period and comprehensive oral examinations, considered crucial for good care because dentists can catch small problems before they become serious and expensive.

Incomplete state reports indicate Atlantic Dental dentists did 8,026 of these checkups during the fourth quarter of 2004. Assuming equal treatment for the other quarters in a year, that would total about 32,000 exams annually -- less than a third of the 100,226 checkups conducted in the last year of the old fee-forservice program.

And the great savings from all this?  Costs in Miami-Dade county have gone up from $14.9 million the previous year to $15.7 million last year.

And here's some of the personal price:

Local 10's Jilda Unruh even talked to a mother who said she had to pull her own child's tooth because she couldn't find a dentist to do it.

Video shows rotted teeth, an abscessed tooth, a cavity untreated for two months, swollen gums and an infection in the bone, all in the mouth of 7-year-old Jamya Holt.

"When I eat, it hurts," Jamya said.

Jamya's mother is outraged that it took two months and calls to five dentists before she could get her daughter an appointment.

"Nobody is willing to see her," Medicaid mom, Aretha Holt, said. "That's pitiful for them to treat children like this. Out of all the people, how could you treat kids like this?"

It hasn't always been this way, Unruh found. Up until July of last year, Miami Dade County Medicaid families saw dentists and the state paid the dentists fees for their service.

But now, state leaders are experimenting with privatizing the Medicaid program in Miami-Dade County.

Thanks ever so much, W!

Oh, and this has all worked so well, they now plan to expand to all medical care under Medicaid.