State’s dental program is in serious trouble

Walter G. Weber
Walter G. Weber

A recent audit of California’s Medi-Cal dental program confirms that the state is failing to provide access to oral health care for millions of children.

The state auditor’s report reveals critical issues with Denti-Cal’s low utilization, abysmal reimbursements and problematic oversight. These failures are putting children at higher risk of developing dental disease, the most common chronic childhood illness, which if left untreated can lead to serious consequences.

In 2013, nearly 56 percent of the 5.1 million children enrolled in Denti-Cal did not receive any care, according to the audit, because the Department of Health Care Services had not, and still has not, ensured an adequate network of providers.

The audit cites Denti-Cal’s reimbursement rates, among the lowest in the nation, as a primary reason for why so few dentists participate in the program. California’s reimbursement rates, which have not increased since 2000, are at only 35 percent of the national average.

Exacerbating the problem, the state hit pediatric dental providers with a 10 percent rate reduction in 2013. The state exempted other pediatric providers from the cut, but not pediatric dentists, based on the erroneous assumption that there would still be sufficient access for pediatric dental patients. The audit makes it clear that this is not the case.

The lack of quality data that led to this mistake is a result of significant oversight issues also revealed in the audit – no annual review of reimbursement rates to ensure they are adequate, insufficient efforts to increase utilization, and data collection that is not meeting federal and state reporting requirements.

In short, the Denti-Cal program is at a critical juncture. The California Dental Association is urging immediate fixes. As an initial step, the state must quickly take action to reverse the 10 percent reimbursement cut and increase rates to acceptable levels. Under the current Denti-Cal rate structure, dentists must provide care at a considerable loss, so many who would like to participate in the program are unable to do so.

The audit indicates state action is needed now, as millions of Californians are obtaining Denti-Cal coverage through the Affordable Care Act, the transition of all children from the Healthy Families Program and through the restoration of adult dental benefits last May. The auditor makes it clear that Denti-Cal will have extreme difficulty ensuring access to timely, quality care for current and new patients without addressing the issues raised in the report.

In particular, unsustainably low Medi-Cal and Denti-Cal payments have limited access for our state’s most vulnerable – medically fragile, developmentally disabled and cognitively impaired children and adults, who require care under general anesthesia. Aside from a small number of the most acute cases, the last facilities to provide such care in the Sacramento area, Sutter Hospital and its Capitol Pavilion Surgery Center, plan to stop at the end of this month due to low reimbursements that do not come close to covering the cost of care for approximately 1,100 special-needs patients each year.

Come January, it is unclear where the parents and caregivers of these patients are supposed to take them for much-needed dental care.

Walter G. Weber, a general dentist in Campbell, is president of the California Dental Association.