A Domestic Policy Subcommittee hearing on Wednesday revealed that in 2001, the Centers for Medicare and Medicaid Services (CMS) issued a contract to update a twenty-year-old guide to Medicaid and pediatric dentistry. Between the draft in late 2001 and the guide's publication in 2004, the document was significantly changed, with major portions deleted.

The changes are much more than simple editing. For instance:

• Data about extent of the problem of lack of access to dental services for children on Medicaid were deleted.
• Statements regarding the legal responsibility of federal and state government to ensure that low-income children receive dental care were deleted.
• Recommendations about state oversight of the dental services of Medicaid managed care organizations were deleted.
• All references to Medicaid reimbursement and payment policies for dental services for children were deleted.

The resulting document stands in stark contrast to reviews by the Government Accountability Office, the HHS Inspector General, the Surgeon General, and CMS itself. All of these analyses identified major failures in access to dental services for children on Medicaid. They also identified low Medicaid reimbursement rates for dentistry as a significant barrier to ensuring adequate access to dental care for children.