California’s Denti-Cal program promises basic oral health care coverage for more than 5.1 million children from low-income families. But nearly 60 percent of these children are unable to get any dental care because of the state government’s history of neglect and its exceptionally low reimbursement rates for dentists who serve Denti-Cal patients.
The lack of access to dentists has led to a crisis in coverage for millions of Californians, placing many of our neediest children at risk. Lack of access also has significant financial consequences for the state. A treatable toothache can quickly turn into something much more serious and costly. Patients frequently show up in the emergency room for treatment – at a tremendously higher cost to the state and taxpayers. And the problem is getting worse.
The program will be the subject of a joint hearing Tuesday convened by the Assembly and Senate health committees and the Joint Legislative Audit Committee. As legislators and Gov. Jerry Brown make budget decisions, they should understand the powerful connection between oral health care, overall health and a child’s ability to learn.
Tooth decay is the No. 1 chronic childhood disease. It is difficult to treat a disease when you can’t find a doctor. If left untreated, tooth decay can cause problems with nutrition, learning and speech. Children with poor oral health care were three times more likely than their peers to miss school, according to the National Institutes of Health. A recent UCLA study estimates California children miss a staggering 874,000 school days annually due to dental problems, at an estimated loss to schools of more than $29 million a year.
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As highlighted in a recent state audit, the problem impacts urban and rural counties alike. Five counties with at least 2,000 eligible children are without any dentists who accept Denti-Cal patients; 11 counties do not have any dentists who will accept new patients; and 16 counties have too few dentists to care for children.
According to the audit, the state neglected to carry out a legislative directive to collect the data needed to determine whether kids who need care can get it. State government needs to start measuring the performance of Denti-Cal as if it really cares how well it’s working.
Low-income and minority students are particularly at risk. Nearly 28 percent of all children ages 2 to 5 have untreated decay in their primary teeth. Among Latino children, that rate nearly doubles to 55 percent; among African American children, it is more than 43 percent.
It is time for the governor and Legislature to keep their promise of basic oral health coverage for our state’s most needy children. This means focusing on expanding access to the underserved children across the state who cannot find a dentist who is willing to see them.
There are a number of things that the state needs to do, but first it has to increase payments to dentists. That is the only way to get more providers to treat Denti-Cal recipients, and to get other dentists to accept new patients.
California has not raised its dental reimbursement rates in 15 years. In 2013, it cut payments to most providers by an additional 10 percent. The state now ranks 48th in the nation for reimbursement rates – less than 22 percent of the average rates paid by insurance companies. Is it any wonder that fewer and fewer dentists can afford to treat California’s neediest children?
In addition to ensuring meaningful access to care, the state must also partner with providers to do more outreach to populations who qualify for Denti-Cal and help educate low-income families on the importance of preventive oral care.
Investing in kids’ oral health care is a wise investment in our future; preventive care will save the state money, increase academic performance and get all our kids ready to join the workforce with a smile. The state can make good on its promises to our neediest children and ensure that every Californian has genuine access to the basic health care that most of us take for granted.
Ronald E. Inge, D.D.S., is chief dental officer of Western Dental, which serves the most Denti-Cal patients of any provider.