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By Craig Palmer

Washington — This is the anatomy of a dental amendment approved Oct. 27 by the House Energy and Commerce Committee. These are the folks who gave it life.

The amendment provides a "slim but meaningful" federal requirement for dental coverage under the federal-state Medicaid program for children who otherwise would lose the benefit, ADA officials said. The legislation without the amendment would have required states to provide access to medical services to children above 100 percent of poverty but not dental services. The new language is less expansive than the Association sought but "a significant first step that organized dentistry can build on as the legislation moves forward," officials said.

Association officials credit a year-long, continuing effort by the dental community "to protect and enhance dental coverage for Medicaid-eligible children." A week before the vote, ADA President Robert M. Brandjord and Executive Director James B. Bramson said in an electronic "action alert" to selected grassroots dentists, "The choices that Congress may make in completing the task known as budget reconciliation could significantly impact dentistry in a host of ways, and we will need your assistance — probably more than once — to support the ADA's lobbying efforts to protect dental programs."

After the vote, Dr. Bramson in a "Dear Friends" message gave an overview of efforts "that lead to this success." Association "thank-yous" extended to:

• the ADA grassroots members and American Dental Political Action Committee who "worked to send a strong and clear message to members of Congress";
• the Georgia Dental Association for "its relationship with key members of the congressional delegation";
• individual dentists singled out for "personal connections" and intervention;
• ADA staff lobbying and advocacy "building a foundation for dentistry's concerns and interests";
• the members of Congress who made it happen, including Reps. Nathan Deal (R-Ga.), Commerce health subcommittee chair, and Charlie Norwood (R-Ga.), the dentist/lawmaker who offered the dental amendment;
• "our dental partners."

"Our success is due to our collaboration with our partnering dental organizations and representatives," Dr. Bramson said. "The dental community fought as a team to protect and enhance dental coverage for Medicaid-eligible children."

Responding to legislation drafted last spring to cut the Medicaid budget, the Association in collaboration with dental partners and other stakeholders developed an action plan to ensure protections for dentistry:

• In coalition with the American Academy of Pediatric Dentistry, Children's Dental Health Project, American Dental Education Association, Academy of General Dentistry, American Dental Hygienists' Association and others, the ADA created a set of Medicaid reform principles. The coalition at a series of House and Senate meetings "expressed one unified voice on Medicaid reform."
• The ADA and ADEA testified to the administration's Medicaid reform commission "on the need to protect and improve the dental Medicaid program as part of any reform effort."
• The Association joined with other coalitions of community and rural health centers, public and children's hospitals and physician specialists to develop alternative reform proposals that would not disadvantage providers caring for Medicaid patients and signed a 30-organization letter asking Congress to protect health benefits for Medicaid-covered children.

Rep. Norwood offered the amendment during committee "markup" of legislation. The Energy and Commerce Committee adopted by voice vote, with no objections, legislation requiring dental services for Medicaid children. Under the amendment, states must offer a dental benefit that equals or exceeds that of the largest dental plan in the state to Medicaid-enrolled children up to 133 percent of the poverty level, a measure that determines financial eligibility for certain programs including Medicaid.

The underlying legislation would have eliminated any dental requirement for children above 100 percent of the poverty level.