A push for better dental care for low-income children

The state Assembly is considering a bill that would double reimbursement rates for Denti-Cal providers in order to entice more dentists to accept the insurance that covers low-income residents.

The hope is to get dental care to more people – especially children. According to recent reports by the state auditor and the Little Hoover Commission, less than 38 percent of the 5 million eligible children actually received Denti-Cal care in 2014.

“The program is not working. There are literally millions of kids who are not receiving quality dental care or, frankly, dental care of any kind.” — Brian Maienschein

Authored by Assemblyman Brian Maienschein, R-San Diego,  AB 15 passed the Assembly health committee but is currently in the suspense file, a holding place for bills with significant fiscal impact. The bill will be reviewed at a later undetermined date.

States are required by federal law to provide dental benefits to children covered by Medicaid (known as Medi-Cal in California) and the Children’s Health Insurance Program. But the state audit report found that 16 counties had either no active Denti-Cal providers or none willing to accept new patients and another 16 counties with an insufficient number of providers.

“The program is not working,” Maineschein said. “There are literally millions of kids who are not receiving quality dental care or, frankly, dental care of any kind.”

His bill would double rates for the 15 most common prevention, treatment and oral evaluation services. An assembly appropriations committee report said the higher rates would cost Denti-Cal $180 million. But some unknown savings would be likely from reduced spending on serious dental procedures that would be unnecessary because of prevention.

Funding for the rate hikes would come from Proposition 56, the tobacco tax initiative approved by voters in November.

Counties with the worst access to dentists for kids included Alpine, Amador, Del Norte, Sierra, Inyo and Mono counties.

The California Dental Association supports the bill, saying that Denti-Cal reimbursement rates are among the lowest in the nation. The state audit report said reimbursement rates for the 10 dental procedures most frequently authorized for payment in 2012 averaged $21.60 or 35 percent of the national average for those procedures.

The reimbursement rate is so low and the paperwork is so onerous that most dentists would rather give away their services than enroll in Denti-Cal, said John Blake, a dentist who works in a Long Beach clinic with 90 percent Denti-Cal patients. He said the only reason his clinic can make ends meet is that 50 percent of their revenue comes from donations.

Blake said raising rates would help but the program should also be overhauled to make it easier for dentists to enroll in the program.

First 5 California, a state agency that invests in programs for children 0-5, considers AB 15 an important “bill of interest” because dental care is a major component of school readiness and enhances a child’s success in school and life.

“It is incredibly exciting to see children’s oral health become a bipartisan issue in California.” Erin Gabel

Tooth decay is the single most prevalent chronic disease in early childhood and is a major cause of missed school days. Dental disease also can cause problems later in life, including pregnancy risk, diabetes, respiratory problems and heart disease.

Denti-Cal is not working because of an “incredible statewide gap in terms of access to care,” said Erin Gabel, First 5 California deputy director of external and governmental affairs.

“There are huge dental access deserts- huge geographic areas where there are inadequate numbers of dentists or dentists that accept Denti-Cal patients, including children,” she said.

The problem is the most severe in rural and Northern California. According to the state auditor’s report, counties with the worst access to dentists for kids included Alpine, Amador, Del Norte, Sierra, Inyo and Mono counties.

Increased dental provider rates could potentially get more dentists in those areas.

In light of huge proposed Medicaid cuts on the federal level, Gabel isn’t sure how much chance AB15 has of being approved, but she is glad that it’s getting attention.

“It is incredibly exciting to see children’s oral health become a bipartisan issue in California,” she said. “It’s on the agenda in a way it’s never been before.”

First 5 Sacramento believes increasing access to dental care is so important that it has built five new children’s dental clinics since 2010, said Julie Gallelo, the agency’s executive director. First 5 Sacramento is one of several county First 5 initiatives who have invested in increasing dental services in their area. The First 5 agencies get their funding from tobacco taxes, which are gradually declining as fewer people smoke.

“AB15 is necessary because we have invested as much money as we possibly can,” she said. “We need a long-term fix and it is fixing the reimbursement rate for dentists.”