Dental managed care plans that came under fire last year for failing to treat large numbers of poor children in Sacramento and Los Angeles counties have made significant strides toward getting those children into dentists' chairs, according to a report submitted to the state Legislature last week.
In 2012, 43.7 percent of Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, the report by the Department of Health Care Services shows. That number represents a marked improvement over 2011, when 32.3 percent of Sacramento children with Medi-Cal saw a dentist, one of the lowest rates in the state.
Numbers in Los Angeles also improved, though they remained lower than Sacramento's: 36.8 percent of Los Angeles children who were enrolled in managed care plans saw a dentist in 2012, compared with 24.6 percent the year before.
In a February 2012 story, the Sacramento Bee highlighted problems with the local managed care dental system, featuring stories of children who waited months or years to receive treatment for broken or badly decayed teeth. State Senate President Pro Tem Darrell Steinberg, D-Sacramento, called on the Department of Health Care Services to take "immediate steps" to fix the situation.
Citing the program's failures in Sacramento, Steinberg and other lawmakers in August called for a halt to the state's plan to move almost 900,000 Healthy Families children into a similar plan, questioning whether managed care was the answer to poor children's dental care needs.
But state officials and managed care plan representatives say they have taken steps to improve the program, and cite several factors, including better oversight, tougher reporting requirements and better communication with parents and advocates.
René Mollow, deputy director of health care benefits and eligibility for the Department of Health Care Services, said she expects to see continued improvement.
"Our goal is not for it to be a one-time effort," she said. "This will be ongoing."
Local advocates laud the improvements but say the managed care program still has a long way to go.
"It's going in the right direction but not nearly as fast as we'd like to see it," said Debra Payne, a health and dental program planner for First 5 Sacramento, who has been a critic of the local dental managed care system.
Since it was started as a pilot program nearly two decades ago, geographic managed care has been mandatory for Medi-Cal children in Sacramento County. It is voluntary for the same population in Los Angeles. Everywhere else in the state, children with Medi-Cal are automatically enrolled in a "fee-for-service" program.
Although beset with its own access problems, that program traditionally delivers better access than managed care. That remained true in 2012, when 51 percent of children with fee-for-service insurance saw a dentist, according to state data.
Last week's report to the Legislature highlighted the actions the state and managed care plans have taken. Among them:
Sending letters and calling beneficiaries to inform them about their eligibility for services.
Requiring better reporting by plans – and creating a system of penalties and incentives to improve the percentages of children seen.
Requiring plans to monitor individual providers, and to be regularly audited by outside agencies.
In Sacramento, an advisory committee has been meeting regularly.
Payne, of First 5, who sits on that committee, expressed frustration that its input was not included in the report to the Legislature.
Among the committee's concerns are: continued complaints from parents of children who were not receiving care; distrust of the quality of the data, which is provided by the plans; the need for more independent monitoring; and skepticism about whether the plans could absorb thousands of new children from Healthy Families this spring.
John Carvelli, vice president of Liberty Dental, the best-performing of the managed care plans, said he feels the managed care program has proved to be a good option, and should be expanded elsewhere in the state.
"I think it's long past ready," he said.
Karen Ziebron, a field representative for Steinberg, said she is pleased to see collaboration among the plans, advocates and state, although she is concerned about the issues raised by the advisory committee.
"It seems like it's a work in progress," she said.
The California HealthCare Foundation Center for Health Reporting is funded by the nonprofit, nonpartisan California HealthCare Foundation. Read more at www.centerforhealthreporting.org