Going to the dentist is an ordeal for Jessica Gustafson and her two young children.
And it’s not just because her 7-year-old son, Aiden, is nervous about sitting in the dentists’ chair. Just to get to the dentist, Gustafson has to wait up to three months for an appointment, and then drive one hour from her home in Ojai to get to the only dentist she can find that will accept her dental plan.
Gustafson and her children are enrolled in Dental-Cal, the state’s dental health care program for people on modest incomes. The program is receiving growing attention amid reports it is dramatically failing to meet the dental care needs of a huge swath of California’s population.
About 13 million people — a third of California residents — are enrolled in Denti-Cal. Of those, about 5.6 million are children. That’s about half of all children living in the state.
Thousands more children are expected to become eligible for Denti-Cal in May as California begins enrolling undocumented kids in state-run healthcare benefits for the poor.
A recent report by an independent oversight agency called the Little Hoover Commission labeled the Denti-Cal program “dysfunctional.” The report, which echoes earlier findings by the state auditor, indicates that only about half of all children enrolled in Denti-Cal actually see a dentist annually, compared to two-thirds of children insured under private plans.
A broken system
Families likely aren’t taking advantage of their Denti-Cal benefits because it’s difficult to find a dentist who will accept them. Many dentists want nothing to do with Denti-Cal because it offers low reimbursement rates and comes with onerous administrative rules, the commission report found. In fact, 11 of California’s 58 counties have no Denti-Cal providers at all or no providers willing to accept new Denti-Cal patients, the report stated.
“It’s a broken system,” said Paul Reggiardo, a long-time pediatric dentist in Huntington Beach, who said Denti-Cal reimbursement rates haven’t changed in 16 years. Reggiardo does see some patients in the program, but it’s become increasingly difficult financially to treat them, even though demand for services is huge, he said.
“The reimbursement level is less than it costs me to provide the care,” Reggiardo explained. “I couldn’t open the doors and pay the rent and pay for the lights if I were entirely dependent on the Denti-Cal reimbursement rates.”
For Gustafson, difficulty seeing a dentist through Denti-Cal has led her to forgo desperately needed dental care for herself, including four root canals. For her son, Aiden, she’s waiting for one of his baby teeth to fall out instead of fixing a cavity, she said. It took six months and eight visits to the Denti-Cal dentist to get two of his other cavities fixed because the dentist would only do one procedure at a time, she said.
“I was losing my mind,” Gustafson said. “It was an hour away.”
Meanwhile, she’s been waiting three months for her 2-year-old daughter to secure a dental appointment. The little girl needs a checkup before she’s allowed to enter preschool, the mom said.
Finding a dentist to do specialized work under the Denti-Cal plan is even more difficult. Martha Luevanos of Los Angeles has been searching since January for a dentist who can put crowns on her daughter’s teeth. The 15-year-old student has no enamel on her teeth and can’t eat properly because it hurts, her mother said. She was told it would cost her $20,000 to fix the teeth out-of-pocket.
“It’s too much money; I just can’t pay that,” Luevanos said in Spanish. “My daughter is holding up, but her teeth are very sensitive. She can’t bite into things with the front of her mouth because it hurts her.”
The Department of Health Care Services, which administers Denti-Cal, has said it is committed to providing beneficiaries with access to quality dental care, and is taking steps to improve the program.
In an email, spokesman Anthony Cava said the department has improved its system for assessing participation in Denti-Cal, is coming up with new plans to bring dental care to people in underserved areas and is trying to simplify administrative rules. He said children’s utilization of Denti-Cal has actually increased since 2011.
In addition, the federal government recently approved up to $750 million in funds for California’s Denti-Cal program over the next five years. The funds are to be used for improving access to preventive dental care, encouraging provider participation, and making available incentives to providers who offer preventive services to children, Cava wrote. According to the California Dental Association, it’s the most substantial investment in Denti-Cal to date.
Alani Jackson, chief of Denti-Cal, told California Healthline last week that the agency plans to spend part of the money on up to 15 dental pilot programs, which will allow community members to weigh in on improving preventative care.
Prevention is key
Jenny Kattlove, senior director of programs at The Children’s Partnership, a nonprofit children’s advocacy group, said the new funding is encouraging and could ensure more children in the Denti-Cal program get the early care they need.
Until now, investment in preventative care under Denti-Cal has been very low, the Little Hoover Commission found. Just 14 percent of Denti-Cal’s $1.3 billion budget is spent on preventative care, while 84 percent goes to high-cost procedures such as drilling, pulling teeth and doing crowns and root canals.
“If the Medi-Cal program continues to operate its Denti-Cal system the way it has been, we’re going to be in an even deeper crisis than we already are,” Kattlove said. “We’re going to have children who can’t learn in school, we’re going to have children who are in pain and are missing school, and we’re going to have kids in emergency rooms and having more expensive treatment.”
Part of the answer to providing better preventative dental care to underserved children could come from a new model called the “Virtual Dental Home,” said Kattlove. Under this model, dental hygienists and assistants take dental care to the children, visiting schools, Head Start sites and community centers to provide diagnostic, preventative and early intervention care. The hygienists use technology to communicate virtually with a supervising dentist at a clinic.
A state law passed in late 2014 paved the way for the expansion of the Virtual Dental Home model. Now, The Children’s Partnership and others are pushing to for $4 million of funding in the state’s budget to help make that expansion a reality, Kattlove said.
Kattlove said she is also encouraged by the appointment of Jackson last year, because it’s the first time in decades that there has been a state dental director. Director Jayanth Kumar is leading the development of a state dental plan, with input from stakeholders including The Children’s Partnership, Kattlove said. The plan will take a comprehensive look at the state’s oral health system, identify problems and come up with solutions, she said.
More needs to be done, particularly to raise reimbursement rates for providers, said Kattlove and dentist Reggiardo.
But Kattlove said she is encouraged by what she sees as a growing momentum among state administrators and legislators to fix Denti-Cal.
“You would not see the energy and efforts within the administration and potentially the legislature five or six years ago,” she said. “The legislature and administration have really come to realize that we have a crisis.”