California can do better by poor kids’ teeth

Rows of dental volunteers treat patients during a CDA Cares Dental event at CalExpo in Sacramento in March.
Rows of dental volunteers treat patients during a CDA Cares Dental event at CalExpo in Sacramento in March. rbenton@sacbee.com

Few pains are more debilitating than toothaches. For kids, a rotten tooth can mean lost days in school.

So when a state audit in December chastised the California Department of Health Care Services for shortcomings that limited access to dentistry for children of low-income parents, legislators and policymakers rightly took notice.

Part of the problem is a lack of dentists in rural California who will treat patients through Medi-Cal. One reason is that reimbursement rates are simply too low.

Now that California is not in the throes of a budget crisis, there would be few places better to invest some of the state’s windfall than on the dental health of children, so long as it is a sustainable expenditure.

The state Senate is advocating that California target $30 million specifically to expand dentistry for poor people by raising state reimbursement rates for dentists, which were cut years ago.

The Assembly proposes a different approach, spreading Medi-Cal money to dentists, but also $15 million to acupuncturists, optometrists, opticians, audiology services, podiatrists, speech therapists and incontinence supplies.

We never understood why lawmakers would end incontinence supplies for adults. Good glasses are vital, too. But if money is limited – and it is – the Senate approach of targeting money at dentistry is wise.

The online journalism site, CaliforniaHealth Report, wrote in 2012 that people living in Eureka would have to drive three to four hours to find a dentist who accepted Medi-Cal reimbursements.

Last December’s audit noted the use of dental services by eligible kids in California ranked 12th worst among states tracked by the federal government. It also showed that payment levels for the 10 most common procedures were only 35 percent of the national average.

Additionally, the audit found, there were no dentists in 11 of the 58 counties who were willing to take new Medi-Cal patients, and 16 other counties had too few providers. Texas, not a state known for lavishing taxpayer money on poor people, managed to rank at the top of the list of states at providing them with dental care.

There are many demands for state money. While the Assembly wants to provide Medi-Cal reimbursement for acupuncturists, the Senate proposes to restore services such as crowns and dentures for adults cut in 2009, at a cost of $67.5 million.

Doctors, hospitals, some health insurance plans and the Service Employees International Union-United Healthcare Workers have embarked on a $10 million advertising blitz urging lawmakers to raise rates paid for medical services.

The overall Medi-Cal increase would boost state costs by $269 million, which could crowd out spending for other worthy programs. Brown administration officials believe there are sufficient numbers of providers for the 12 million enrollees, which suggest rates are reasonable, though not extravagant.

A more manageable sum would be $30 million for dental services. That won’t solve access issues overnight. But at least the raise could mean that the dentists who already accept Medi-Cal patients won’t drop out of the program.