After two decades of dissatisfaction with low provider reimbursement rates, insufficient state oversight and a gap in treatment for low-income children, Sacramento County is seeking to change a historically underused state dental program.
Sacramento is one of only two counties in the state where managed dental care (vs. fee-for-service care) is offered, and the only county where it’s mandatory for Medi-Cal families. The latest report on the Sacramento Geographic Managed Care program, released Thursday, showed that only 40 percent of enrolled families receive the managed care services for which they are eligible. In response, the California Dental Association is urging the state to eliminate the program and go another route.
“Pilot programs are meant to be short-term opportunities to show if there’s a better way to accomplish something,” said dentist and CDA President Ken Wallis in a news release. “After 20 unsuccessful years, we’re convinced that this pilot has run its course. ”
The state introduced the program in Sacramento in 1994 as a pilot program to reduce spending. Since then, local dentists and child health advocates have been criticizing the lack of providers willing to accept the low reimbursements for managed care and the high numbers of children not accessing dental services. They brought the recent report Tuesday to the Sacramento County Board of Supervisors to make a plea for action.
“We will march on the Capitol if we need to,” said Cathy Levering of the Sacramento District Dental Society, which first proposed scrapping the GMC program in the early 2000s. “It’s just been Band-Aid after Band-Aid with no real solution.”
The first major report on the program, published in 2010 with support from child health nonprofit First 5 Sacramento, put the rate of use at 20 percent. Since then a number of initiatives prompted by Assembly Bill 1467 in 2012 have doubled that rate to 40 percent, but it still lags behind the statewide average of 52 percent, according to the new report.
“At what point does this board begin to turn this ship around?” said Supervisor Phil Serna on Tuesday. “We can’t even get anywhere near the bottom of where we need to be. I don’t want to be having this discussion again next year.”
Alani Jackson, chief of Medi-Cal Dental Services, said the department has no plans to end the managed care program in Sacramento or make it optional. She and her staff have been doing outreach to providers and patients to improve utilization rates statewide, she said.
“We take very seriously any critiques that are made about our program,” she said. “A lot of the issues in this report are already being worked on.”
Part of the solution, she said, might lie in the new 1115 Medicaid Waiver – a $750 million state and federal grant partially dedicated to funding local programs that improve access to dental care. That may be an opportunity to increase incentives for physicians willing to take on more GMC beneficiaries, she said.
The Sacramento Medi-Cal Dental Advisory Committee, which serves as a liaison between local providers, the county and the state, is also looking for solutions in the new waiver. But in the meantime, they’re trying to improve the program.
At the Tuesday meeting, committee members told the board they needed better and more transparent data from the state health department about provider access throughout the county and more up-to-date information about provider reimbursement rates. They also expressed a desire to work with the state on hospital payment guidelines for children requiring general anesthesia for dental work.
When asked if the committee supported the California Dental Association’s suggestion to end the program, representative Kate Varanelli said committee members needed to discuss the issue further.
When legislation was being written in 2012, the committee pushed the state to make the GMC dental program voluntary for Sacramentans. In Los Angeles, where the program is optional, only 19 percent of Medi-Cal enrollees choose managed dental care over fee-for-service care, the new report shows.
Following the committee’s suggestions, the state built in a “beneficiary dental exemption,” which Jackson said helps managed care recipients connect with providers in their plan. If a provider can’t be found, the department helps families transfer to fee-for-service care, she said.
But Terry Jones, a dentist and chairman of the Sacramento Medi-Cal Dental Advisory Committee, said that measure does not go far enough.
“There is an entire generation of families being raised and neglected by a program that was intended to be a pilot,” he said. “They’re not being given the option to move out of GMC. (The committee) offers a voice to the people in our communities. That voice needs to be heard, and noticed, and acted upon.”
GMC is a state-operated program and the county Board of Supervisors, though concerned about child dental health, said they were unclear on what they can do to change the model. They agreed to discuss the issue further and bring a recommendation back to staff.