Seeking to break managed care's monopoly on dental care for Sacramento County's poor children, state Senate President Pro Tem Darrell Steinberg plans to introduce legislation to allow more choice in dentists, his aide told the Sacramento County Board of Supervisors on Tuesday.

More than 110,000 Sacramento County children on Medi-Cal participate in a mandatory dental managed care model, the only one of its kind in the state.

But that model also has one of the worst records of care: In fiscal 2010-2011, 30.6 percent of Sacramento County children with Medi-Cal saw a dentist, compared with nearly half of the children on Medi-Cal statewide.

The Sacramento Democrat's bill, which he plans to introduce next week, would give Sacramento children the option of a fee-for-service model, which pays dentists for each visit they report, said Steinberg's health consultant Diane Van Maren. The measure also would include beefed-up consumer protections, she said.

If approved, it would take effect July 1, she said.

"There is an immediate need for change here in Sacramento," Van Maren told the supervisors. "Managed care alone clearly is not working."

Under a managed care model, the state contracts directly with private dental plans, paying them a monthly fee – about $12 – for each Sacramento County Medi-Cal child assigned to them, whether the child sees a dentist that month or not.

Critics of Sacramento County's program, which began as a pilot program nearly two decades ago, say it discourages dentists from seeing patients because they get paid either way.

But state Department of Health Care Services Director Toby Douglas, in previous correspondence with Steinberg, has said it would be "most expedient and effective" to keep Sacramento kids in the managed care program because the state may have to alter agreements with the federal government, which provides some Medi-Cal funding.

Instead, Douglas has proposed changes to the existing model, such as resolving patient complaints more quickly and getting tougher on dental plans that fail children, even terminating their contracts.

At least two Sacramento County supervisors questioned the concept of sticking with mandatory managed care.

Board Chair Don Nottoli, who remembers the early promises made when mandatory managed care went into effect, said the program has resulted in "abysmal rates."

Supervisor Phil Serna, who chairs First 5 Sacramento, added a sense of urgency to the discussion, calling on county staff to update him every few weeks on the issue.

"Over the course of 18 years, you kind of ask yourself … why is this taking this long to address?'" he said.

Toni Moore, executive director of First 5 Sacramento, called on the supervisors to take a stand on the issue, even though the state has authority over the program.

"We need stronger county leadership around this because, quite frankly, it hasn't been there," she said.

Serna responded immediately: "In response, Toni, to your recommendation that the county own this, I'm owning this," he said.

The three other supervisors – Roberta MacGlashan, Susan Peters and Jimmie Yee – remained silent during the discussion and did not return previous calls for comment.

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