Despite reform efforts, California’s Medicaid dental program draws renewed criticism

Photo: Omar Bárcena via Flickr

Photo: Omar Bárcena via Flickr

A California watchdog commission’s recently released report offers a scathing assessment of Denti-Cal – the state’s historically troubled Medicaid dental program.

“Among government programs labeled by participants and beneficiaries as broken, dysfunctional or an outright mess, few have achieved the notoriety of Denti-Cal,” noted the Little Hoover Commission.

The independent state oversight panel, which conducted a seven-month review of the Denti-Cal, described the program as being caught up in a “vicious circle of dysfunction:”

Most dentists in the state refuse to participate because of low reimbursement rates and bureaucratic hurdles. A chronic shortage of willing providers has contributed to a severe lack of care. Among the state’s 13 million beneficiaries, only about half the state’s Dent-Cal children and a quarter of Denti-Cal adults obtain dental services. At least five of the state’s 58 counties lack any participating dental providers.

“Millions of Californians, consequently, are going through life with rotting or missing teeth, debilitating pain, poor oral health habits and no preventative care,” said the commission, noting that many Medicaid beneficiaries in the state don’t even know they are eligible for dental benefits.

The commission called for a “restart” of the program that would streamline bureaucratic hurdles for dentists and expand care – particularly preventive care – to patients through the use of tele-dentistry and virtual dental home models, medical offices, safety net clinics and school and community-based services.

“None of these involve big, costly, across-the-board hikes in reimbursement rates to attract a few more Denti-Cal providers,” wrote commission Chair Pedro Nava in a letter introducing the report. “Presently, Denti-Cal spends just 14 percent of its $1.3 billion budget on the preventative checkups that people with commercial insurance take for granted. The other 86 percent pays dentists to drill, fill, cap and extract – a formula that dooms Denti-Cal to a state of constant emergency and perennially being hauled before the legislature to explain its inability to keep up with demand.”

In spite of the long history of dysfunction, the commission found reason for hope in new federal attention to the program. Late last year, the U.S. Department of Health Care Services and the Centers for Medicare & Medicaid jointly announced a five-year, $740 million Dental Transformation Initiative to help stimulate new approaches to care for Denti-Cal beneficiaries, the report noted.

In the wake of the commission’s paper, Ana B. Ibarra of California Healthline caught up with Alani Jackson, who has lead Denti-Cal for the past year.

In that interview, Jackson told Ibarra about pilot programs being established with the help of the initiative and spoke about stepped up efforts to inform beneficiaries about their eligibility for dental care.

But important questions remain.

“Next month, 170,000 undocumented immigrant children will be eligible for full-scope Medi-Cal,” Ibarra said. “Will these children be able to get dental services in a timely manner?”

“Absolutely,” Jackson responded. “They’ll be enrolled and provided with information on how to access services, as are all newly eligible children.”

Yet, as Little Hoover pointed out, for millions of beneficiaries, those services have long proven very hard to find for current recipients.

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