Broken teeth and useless coverage: Is this how government health care should look?

When people can’t afford to fix their broken or crooked teeth, it’s not just a cosmetic problem. It often stands in the way of getting a job.

So why is it so hard for Californians with dental coverage through Medi-Cal to get the care they need? A Fresno Bee investigation raises questions about the Department of Health Care Services’ (DHCS) administration of the program. It also provides a striking example of why some people believe government should stay out of the health care business.

The reporting was part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.

Fresno Bee reporter Manuela Tobias found that less than a quarter of adults with Medi-Cal saw a dentist in the last year, and patients are turning to extreme measures in an attempt to receive care. Some have pulled their own teeth to cope with pain. One woman with Medi-Cal coverage is running a GoFundMe campaign to raise the $4,000 she needs to pay for care.


The department “attributed the low participation rate to people not prioritizing their dental health. But interviews with more than a dozen dentists, advocates and patients suggest low participation rate in the $2 billion program is because of the challenges dentists face in getting paid for their work,” writes Tobias.

Struggle for authorization

Many dentists don’t take Medi-Cal because reimbursements are low compared to private insurance. Dentists who do accept Medi-Cal struggle to get authorization for necessary procedures. And even when they get authorization, some must wait months for reimbursement.

When patients and dentists seem unable to get the agency to pay for procedures that are supposed to be covered, it makes you wonder how DHCS is spending that $2 billion. The state needs to fix whatever issues are keeping California patients from getting care their plans supposedly cover.

The department is “extraordinarily concerned about fraud,” according to Pedro Nava, chairman of the Little Hoover Commission, an independent state oversight agency that has studied the department. If that concern is getting in the way of patients who need care receiving it, perhaps the state’s authorization procedures need reform.

California might also learn from other states. In Utah, for example, the state combined forces with the University of Utah School of Dentistry to combine dental care with other social services.

“With a federal grant from the Health Resources and Services Administration, the dentistry school began providing comprehensive oral care to a group of around 300 individuals receiving treatment for their substance use disorder,” she writes.

Discharged patients who received dental care were less likely to experience homelessness, less likely to resume drug use and more likely to get a job – in stark contrast to what happens when people fail to receive dental care.

Costly failure

Between 2005 and 2016, 11 percent of avoidable emergency room visits in California were for dental issues, according to a Public Policy Institute of California study.

Lack of access to dental care locks poor people out of jobs when hiring managers find their teeth off-putting.

“It’s almost never talked about, but the tacit discrimination people face because of their crooked or missing teeth can be devastating. Many will never know why they didn’t get a particular job, or were laid off,” writes Tobias.

When a program fails to do its job, taxpayers will rightfully wonder whether California is spending resources wisely. Medi-Cal’s dental coverage as currently administered by DCHS is as good as having no insurance when it denies patients access to care they critically need.

Dental coverage is essential health care that helps people build the foundations of a stable life. Whether with money or creative effort, the state needs to find a way to make sure people get the services covered by their insurance plan.

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