A California program that subsidizes the cost of dental services for millions of low-income children and adults has come under scrutiny in recent months for the relatively small number of people served. Critics say they hope the attention will finally drive positive changes in the program commonly known as Denti-Cal.
The most recent round of criticism was kicked off by a State Auditor’s report in December that took the program to task for treating less than half of the 5 million children signed up for low-income health services in California. Lawmakers echoed the critiques at a joint hearing of the Senate and Assembly health committees in March.
Earlier this month, two Democratic lawmakers – Assemblyman Jim Wood, a dentist; and Sen. Richard Pan, a pediatrician – asked the state’s Little Hoover Commission to review the Denti-Cal program, which is administered by the Department of Health Care Services and funded through Medi-Cal. The legislators said they want the commission to devise recommendations that would result in Denti-Cal serving a larger share of low-income children.
“These are the most vulnerable people in our society, and we’re judged on how we treat the most vulnerable people,” said Wood, who was elected to the Legislature last year after a quarter-century practicing dentistry in the Sonoma County town of Cloverdale.
Among the program’s problems, Wood and Pan said, are low reimbursement rates that dissuade dentists from accepting Denti-Cal patients. Only Mississippi pays dentists less than California to treat low-income patients, they said.
Wood said that after years of treating Denti-Cal patients he decided it was easier to provide services for free rather than trying to get reimbursed by the government. “A lot of dentists are choosing to provide treatment pro bono rather than go through Denti-Cal,” he said.
The auditor’s report said Denti-Cal pays dentists about 35 percent of the national average for the 10 most common dental procedures. Rates haven’t increased since the early 2000s and were cut 10 percent for children’s services in 2013. Adult Denti-Cal services were eliminated entirely for a time.
The auditor’s report said low reimbursement rates accounted for the relative scarcity of dentists willing to provide treatment for children eligible for Denti-Cal. In 2013, five counties lacked any active Denti-Cal providers for children, while a dozen counties had no dentists willing to accept new child Denti-Cal patients, the report said. Many other counties, including Sacramento, El Dorado and Yolo, had too few dentists to serve the population of children receiving Denti-Cal benefits.
The lack of dentists, in turn, is part of the reason such a low percentage of children receive treatment, the auditor’s report said. It found that 44 percent of the kids enrolled in Medi-Cal, the state’s version of the federal Medicaid program for low-income residents, received treatment through Denti-Cal in 2013.
Pan said a lack of oversight by the Department of Health Care Services was equally troubling. The department hadn’t reviewed reimbursement rates for more than a decade, despite a state law requiring annual reviews. Nor had it made sure Denti-Cal contractor Delta Dental provided care in underserved areas, the auditor’s report said.
“They’re running the program with a lack of oversight and a lack of accountability,” Pan said.
Jennifer Kent, who took over as director of the Department of Health Care Services about two months ago, said she’s hoping to change the perception of Denti-Cal by reducing red tape for providers, streamlining the reimbursement process and increasing services to rural areas, including the use of mobile dental units.
“I think in a year you’re not going to be having the same conversation about the program,” Kent said. Rather than talking about “all the things that are going wrong, I think we’re going to be talking about all the things that have improved.”
But paying dentists at higher rates is problematic, she said. Even a slight increase in rates, multiplied by millions of patients, would have a major impact on state spending, Kent said. The budget proposed by Gov. Jerry Brown in January does not include any increase for Medi-Cal or Denti-Cal spending, she said.
Whether the May revision of the budget proposal will include increases is in question. Patient advocates are putting pressure on state officials to increase spending as the economy improves and to institute other wholesale upgrades to Denti-Cal.
“The audit report affirmed what advocates had been saying for so many years,” said Eileen Espejo, health policy director at Children Now, a statewide group that promotes children’s well-being. “It gave policy makers more ammunition to hopefully make real changes. That’s why there’s so much hope right now.”