After nearly a decade of cuts and incomplete coverage, Californians enrolled in the state’s low-income dental program have full coverage this year.
But whether there will actually be enough dentists willing to accept the low-reimbursement rates and red tape often attached to the Denti-Cal program remains to be seen.
Denti-Cal provides dental services to roughly 14 million children and adults statewide. But coverage for the 7 million adults enrolled was hobbled for years following the 2007 economic recession.
Services were reduced to little more than tooth extractions in 2009. Lawmakers restored coverage for more basic services, such as fillings and x-rays, in 2014. But only this year did coverage for critical services, such as root canals and partial dentures, return.
“This is a big deal,” said John Luther, chief dental officer for Western Dental. Western Dental is the biggest Denti-Cal provider in California, with more than 190 offices statewide. About 10 to 12 percent of Western’s 2.5 million annual patient encounters involve Denti-Cal enrollees.
Dental coverage is tied to other health outcomes as well. Luther noted that poor gum health is a chronic inflammatory condition and makes diseases such as diabetes more difficult to control. He believes the restoration of dental benefits will be a significant boost to the overall health of Medi-Cal enrollees over the long run.
Full Denti-Cal costs about $1.3 billion a year—about 1 percent of the budget for Medi-Cal, the state’s low-income health program.
Restoring the Denti-Cal benefits cost about $400 million. About $140 million for Denti-Cal came from the Proposition 56 tobacco tax funds. Funding also came from the federal Medicaid budget, which matches state dollars. The Prop. 56 funding will increase another 50 percent next fiscal year to $210 million.
“This continued commitment to increase access to care will reduce dental-related emergency room visits and improve long-term health outcomes,” Natasha Lee, president of the California Dental Association (CDA), said in a statement.
In 2017, the state increased reimbursement rates to dentists for fillings and other services by about 50 percent. But according to CDA spokesperson Alicia Malaby, the rates are still about a third of what dentists normally receive from private insurance or patients who pay out-of-pocket. For example, the maximum Denti-Cal reimbursement for scaling and root planing—a deep cleaning of teeth below the gum line that takes a minimum of two visits—is $200. Many dentists charge $1,000 or more for the service.
“It’s very difficult for some dentists in smaller practices to see many of these (Denti-Cal) patients,” Luther said.
As a result, there are significant gaps in dental providers willing to participate in Denti-Cal. According to current data from the Department of Health Care Services, there are no Denti-Cal participating dentists in 13 of the state’s 58 counties, primarily in rural Northern California. In seven counties, there is only one participating dentist. In San Francisco, there are only 20 dentists and orthodontists to serve roughly 150,000 Medi-Cal enrollees.
A 2016 report by the Little Hoover Commission raised concerns about the lack of Denti-Cal providers and noted that the Medi-Cal program created too many hoops for would-be participants, including an application form that was 34 pages long. That’s since been trimmed to 15 pages.
Karen Becerra, a dentist and chief executive officer of the Gary and Mary West Senior Dental Center in San Diego, where about 80 percent of patients are enrolled in Medi-Cal, said that the state appears to be approving authorizations for treatment more quickly recently. It took only two weeks to OK a recent scaling, she noted. Prior to 2009, it took four to six weeks before such a service was approved, she said.
Although Becerra is heartened by this, she still wants to see how the benefit restoration rolls out in the coming months.
“We are waiting to see what will happen,” she said.
While Luther believes there won’t be a large initial surge of new business, there will be a pent-up demand of people with poor oral health who will need care.
He and Becerra noted that many dentists may remain on the fence about accepting Denti-Cal patients if they believe the benefits may be cut again in the near term.
“To say coverage is restored and all is well it not really the truth,” Luther said. “In all fairness to the dentists, in order for them to accept new patients or expand offices, they have to know that this is sustainable.”