Lack of funds hurting dental care in California

Dental care in California is hurting

A recent investigative report has come down heavily on the state of dental health and facilities in California for low-income children and adults. The dental health system has been called ‘dysfunctional’ by the report.

The state government’s dental health program, Denti-Cal, has many deficiencies as per a report released in 2016 by the Little Hoover Commission, which is an independent oversight agency. Under this program, about one-third of the state’s population can avail Denti-Cal to get subsidized dental care. This includes the state’s more than half of the children.

The report has put most of the blame on the governor’s office, the Mayor, and the political culture of California, which resulted in years of strategic misdirection and neglect.

In fact, Pedro Nava, the commission’s chairman has used strong words to describe the state of affairs. “In California we have kids’ teeth rotting out of their heads,” he said. “That’s utterly inexcusable,” reported Kaiser Health News.

The report points out that California is facing an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care.”

DHCS is committed to Denti-Cal

The Department of Health Care Services (DHCS) runs Denti-Cal while overseeing Medi-Cal, California’s version of Medicaid. The department released a statement saying that it aims to correct problems. “DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”

According to DHCS, about 44 percent of the children who can receive dental services — 2.5 million of them — were recorded to have had a dental visit in 2013-14, and only 23 percent or 1.5 million of eligible adults visited a dentist.

Funding is root cause of dental health woes

Unavailability of sufficient funding is a major reason why program has failed the expectations of Californians, and this includes funding from the legislature and low rates of reimbursement.

For the 10 procedures most often authorized for payment in 2012, they averaged $21.60 in state reimbursement — about “35 percent of the national average of $61.96 for the same 10 procedures in 2011,” as per a 2014 state auditor report.

Numerous dentists complain that they lose money on patients who are state-funded. For example, there’s John Blake who gave up a private dental practice in Long Beach to operate the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.

Blake says that while the business is nonprofit, 25 percent of his overhead is paid through fundraising events and donations, and state funding is not enough.

“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake says. “They just gave up.”

Dentists also feel hassled by too much bureaucracy. According to the Hoover Commission report, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest.”

The report addressing the hassle factor, noted that time-consuming and complicated pre-authorizations for basic procedures are major concerns along with difficult paper-based billing system, and a 22-page application form used to apply for participating in the program.

Lack of awareness is denting the program

Many poor people who can avail the program’s benefits are unaware of it. In Los Angeles, Ruth Sandoval, a mostly Spanish-speaking mother of two, said didn’t even know that she and her family were eligible for the Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” said Sandoval, who was relieved when she finally visited a dentist.

Though dentist Camille Nishikawa said she doesn’t face some of the problems cited by the report. She operates the QueensCare mobile dental clinic in Los Angeles along with USC Medical Center. The clinic travels to schools in some of the poor parts of the city to offer dental care to children. The dental vans are given grants and the program doesn’t take any money from Denti-Cal or patients.

Santa Monica-based Children’s Partnership advocacy group’s Jenny Kattlove feels that people think dental health is just about cleaning teeth and are not aware about full ramifications of dental diseases. “Look, when children don’t get the oral health care they need, they suffer in pain,” said Kattlove. “Untreated dental problems actually can lead to death; I don’t know what’s more health-related than that.”

DHCS has its work cut out. The problem of people not having access to state-funded dental care will worsen after more children, about 170,000 illegal children, become eligible for full Medi-Cal benefits including dental care.