The number of dental providers willing to treat Medi-Cal enrollees has decreased significantly in recent years, according to testimony state officials provided last week to the Hoover Commission, an independent state oversight agency.

The Little Hoover Commission issued a scathing report on the Denti-Cal program in 2016, saying it was failing low-income Californians, and pressed for reforms from the Department of Health Care Services (DHCS), which oversees the Denti-Cal program.

While some of the changes have been made, progress has been slow. “Navigation to the right provider at the right time continues to be a challenge,” DHCS Director Jennifer Kent acknowledged. According to DHCS data, about 44 percent of Denti-Cal enrollees under the age of 20 visited a dentist in 2017. The state Legislature mandates an annual visit rate of 60 percent, but Kent said that DHCS is focused on getting it up to only 47 percent in the next couple of years.

Meanwhile, the number of dentists who accept Denti-Cal, the state’s insurance program for low-income people, dropped by 8 percent between 2013 and 2017, although it rose slightly between 2016 and last year.

Officials from DHCS, which oversees both the Medi-Cal and Denti-Cal program, did not provide an explanation at the hearing as to why the number of providers had declined.

However, the virtual elimination of Denti-Cal benefits for adults from 2009 to 2014 due to budget cuts and the low reimbursement rates for services compared to what private sector insurers pay are considered by dentists and other observers as the primary culprits for the decline.

Efforts to encourage more dentists to accept Denti-Cal include streamlining the once onerous process for enrolling in Denti-Cal. Renewing their participation has been streamlined from filling out four forms to one form. That helped more than double applications submitted in October 2017 versus October 2016.

Yet only 78 applications were submitted last October – and it took nearly six weeks on average to process each application – suggesting it could take years to grow the Denti-Cal provider network.

Another $2 million has been earmarked for outreach and marketing to encourage more dentists to participate, although that money has not yet been spent, officials said.

“DHCS’s recent Denti-Cal provider data highlights serious access problems to dental services for children and adults on Medi-Cal,” said Linda Nguy, a policy advocate for the Western Center on Law & Poverty. “At a time when Denti-Cal providers should be increasing, it’s shocking that the number of Denti-Cal providers has dropped.”

But Conrado Barzaga, M.D., executive director for the Center on Oral Health, an advocacy organization in Pomona, believes that the reduction now more accurately reflects the providers participating in Denti-Cal.

It seems in the past, many providers who had signed up to participate in Denti-Cal did not actually provide any services. “The new numbers reflect in actuality the number of dental providers who do participate in the Denti-Cal program,” he said, but added that that total was “not even close” to what is required to make the program work effectively.

Little Hoover Commission spokesperson Tamar Lazarus said the hearing was part of an information gathering process, and the body is likely to issue a report with further recommendations later this year.

Several people testified at the hearing about the ongoing issues of finding dentists for themselves or their children.

Robin Blanks Guster said she had to take both her 3-year-old granddaughter and 25-year-old daughter, both Denti-Cal enrollees, to hospital emergency rooms when she had trouble finding a dentist willing to pull their infected teeth. One dentist who claimed to have pulled one of her daughter’s teeth did not actually do so. “That’s fraud in my book,” she said.

Laurie James testified about struggling to find any information at all at the local social service offices about dental coverage in Amador County, where she lives. She only found out about the Denti-Cal program through a friend who works for California Department of Public Health. She was then able to find a dentist in Rancho Cordova who was willing to treat her two grandchildren – until she received a letter saying the practice would stop accepting Denti-Cal at the end of 2017. She dreads finding another provider, saying that that practice, Smile Kingdom Dental, provided a kind and respectful atmosphere.

“Let’s be realistic…I used to work in doctors’ offices and do medical billing. Medi-Cal patients are looked down upon – it’s just the truth,” she said. “My grandkids were never looked down on in Smile Kingdom, and I wonder if they’re going to be treated with respect at the next dentist. It’s a huge concern of mine – all I can do is cross my fingers.”

Little Hoover Commission Chairman Pedro Nava expressed sympathy to those who testified, noting that finding a dentist may boil down to whether they have friends or acquaintances who are aware of the Denti-Cal program and how it works.

“I don’t think we can ever lose sight that it should not be this hard,” he said.