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Online reporter discusses her coverage of challenges at California’s Medicaid dental program Date: 06/15/16

Ana Ibarra

By Mary Otto

Denti-Cal, California’s Medicaid dental program faces ongoing challenges in getting care to its roughly 13 million beneficiaries. Currently, only about half the children and a quarter of the adults covered by the program are getting dental services.  A shortage of participating dentists is a major problem and there are other troubles as well.

Many of the state’s Medicaid beneficiaries may not even be aware they are eligible for dental care under the program, according to a new report by a state watchdog commission. Meanwhile, thousands of undocumented children are joining the state Medicaid rolls, and they too will be entitled to dental care. How will Denti-Cal navigate the road ahead?

In a recent piece for California Healthline, reporter Ana Ibarra offered a look at efforts to reform the system. In this Q&A for AHCJ, Ibarra reflects upon the future of Denti-Cal and discusses the rest of her complex and rich beat as a web reporter for California Healthline. She also shares some advice on the value of journalism fellowships in developing skills and making connections that can help reporters excel.

Q: California's Medicaid dental program has had a long history of problems. As you reminded California Healthline readers recently, fewer than half the beneficiaries in the state actually are getting dental appointments – in part because of a serious shortage of dentists. The shortage of Medicaid dental providers is a problem that reporters in other states are writing about as well. What seem to be the most promising solutions that you have heard about, in talking with Denti-Cal chief Alani Jackson and others in California?

A: At this point it seems the Denti-Cal office is putting a lot of hope on its Dental Transformation Initiative – which provides the office with $750 million in state and federal money for five years. Jackson has said this funding will go toward improving access, which includes incentivizing dentists to participate in the Denti-Cal. However, this is a long-term solution. More immediately, there seems to be a push for making use of oral health programs available at community health centers. At least in some smaller communities, this seems to be the go-to dental option for many families.

Q: As you pointed out in a recent story, a new report from an oversight panel called the Little Hoover Commission summed up Denti-Cal as "an outright mess." Earlier this year at your previous job at the Merced Sun-Star, you wrote about another dental report from a group called Children Now that gave the state a D-plus grade and highlighted the shortage of poor children getting preventive dental services.  What advice do you have about finding, reading and using these kinds of reports in a reporter’s beat coverage? And are there questions that the reports have raised that you hope to follow up on?

A: I think most journalists know there are plenty of reports out there published by nonprofits, universities and such, and it’s just a matter of carefully assessing the quality. In Merced, I usually opted for reports that provided county-by-county information, as well as statewide data, because readers appreciate knowing how their county is doing compared to other areas of the state. Also, when reports continue to show the same thing – in this case that Denti-Cal is struggling – I think that’s worth noting.

Q: In addition to its longtime struggles, Denti-Cal will be facing a new challenge soon, as you reminded Alani Jackson in your interview. Approximately 170,000 undocumented immigrant children have become eligible for the full scope of Medi-Cal coverage, including dental services. Will you tell us a little more about this situation, and how state officials are planning on getting care to these children?

A: Undocumented children under the age of 19 are now eligible for Denti-Cal. Most undocumented children were already receiving restricted-scope benefits, but now those services will include dental care. The expansion was authored by Sen. Ricardo Lara and signed into law by Gov. Jerry Brown last year. When I spoke to Denti-Cal officials about this, they seemed very confident that these children would be able to access services. The Denti-Cal team, Jackson said, was very much involved with the implementation plans of the expansion, and anticipate what’s coming. Not much detail on how they would go about this was given, but they didn’t expect the influx of the newly eligible to be an issue. It will be interesting to check in a couple of months how this process is rolling out.

Q: You are a bilingual journalist. Can you share a couple of examples of how your language skills have helped you in your work?

A: First of all, I think being bilingual has helped me land the jobs I’ve had. In California it’s always a plus to have a Spanish-speaker in the newsroom or on the team. Actually, I have never been to a job interview (even prior to journalism) where I was not asked if I spoke Spanish.

Out in the field, I think it is pretty common knowledge that the more comfortable someone feels around you, the more they are willing to share. This, of course, is most useful when interviewing people for stories related to underserved, mostly Latino communities. Also, I think it’s important to note that building this sense of comfort, especially when interviewing Spanish-speaking Latinos, goes beyond speaking their language – there is a lot of value placed on being able to connect culturally. I think some of my better interviews turned out to be in “Spanglish” – at that point people really opened up as if they were having a conversation with a neighbor.

Q: Have you had an opportunity to see how language barriers contribute to health disparities in the communities you are covering?

A: I think simply the thought that it may be difficult to communicate with one’s doctor makes people uneasy and hesitant about seeking basic preventive services. As we know, health disparities are influenced by factors such as access to insurance and access to reliable transportation, for example, and these are issues often faced by low-income, non-English speakers.

Q: Not too long ago, you received a California Health Journalism Fellowship. Was that a useful experience for you? Do you have any advice for fellow reporters who might be thinking about seeking a fellowship?  

A: Absolutely. I was a CHJ fellow last year and that was a neat experience. As part of the fellowship, I spent a week with a mix of health care reporters— veteran reporters with wealth of knowledge, and others who like me were fairly new, but were covering communities with similar issues, so there was some swapping of ideas. I met some of the Kaiser Health News reporters I now work with during the fellowship program, so there is always the perk of networking. (Editor’s note: California Healthline is a service of the California Health Care Foundation and produced by Kaiser Health News.)

I didn’t realize how many fellowship opportunities there are out there. I think one piece of advice I can offer is that reporters should be on the lookout for these programs and apply. Especially reporters working in smaller papers or organizations. Fellowships are great support in tackling a big picture project, which sometimes are difficult to complete with limited resources in the newsroom.