"Model" Dental Program Ultimately Painful for Children

By Kelley Weiss, Center for Health Reporting

Since February, reports from the CHCF Center for Health Reporting and The Sacramento Bee have painted a grim picture of low-income children waiting for months or even years to see a dentist in Sacramento. And now some state lawmakers are calling for immediate action.

Almost two decades ago the state started a managed care pilot program in Sacramento County for children’s dental care. Since then, several families have described harrowing instances of long wait times and unsuccessful attempts to get through the red tape.

Alisa Erickson testified at the state Capitol on March 15th about her 18-year-old daughter’s struggle to get dental care in Sacramento.

“Her cheek was actually swollen and she was in so much pain, that she missed school, she could not sleep because every time she laid down … her tooth would throb so bad she’d start crying,” Erickson says.

Erickson’s daughter, Stephanie, has coverage through Medi-Cal -- a program for low-income Californians. But Erickson says it took three years to get a broken tooth pulled. That’s because through her coverage, she couldn’t find any dentists to see her daughter. By the time she got treatment, it had gotten much worse.

“My daughter, the damage has been done,” Erickson testified. “All her teeth have been pulled.”

Last year less than a third of Sacramento’s 100,000 children with Medi-Cal saw a dentist. That’s compared to a state average of nearly 50 percent, which makes Sacramento one of the worst counties for kids to access public dental benefits.

Ongoing issues with Sacramento’s dental program were documented in a First 5 Sacramento report [PDF] presented to government officials in 2010.

And Senate President Pro Tem Darrell Steinberg, D-Sacramento, says children from low-income families shouldn’t be suffering like this.

He’s trying to change what’s called Dental Geographic Managed Care, or GMC, in Sacramento County. It’s a closed network of providers that get paid a flat monthly rate of about $12 for each child enrolled in the program. That’s whether they see them or not. But around the state, most children with Medi-Cal are not enrolled in dental managed care. But in Sacramento, that’s not the case: it’s the only county where kids have to be in this kind of program.

Steinberg recently introduced a bill to even the playing field for children in his district of Sacramento.

“We want to push for a voluntary program where there is some choice here, because when there is more choice more likely kids will get the access quickly,” Steinberg says.

Steinberg’s bill still has a long way to go. It needs lawmakers’ approval and then Governor Brown’s signature. The bill calls for much greater oversight of the health plans. And for regular reports to the Legislature about progress.

But California’s Department of Health Care Services director, Toby Douglas, says he wants to stick with the current mandatory dental program.

“We strongly believe that managed care done right with really, really strong accountability, and working with our plans to make sure that providers are providing the right care, that it can be the right model,” Douglas says.

At the same time Toby Douglas is responding to the public scrutiny of the program now. He says audits of the health plans in Sacramento are underway. And Douglas says the state will pay providers more if they see more children. If they don’t, Douglas says they won’t get paid.

But health care consultant Barbara Aved is skeptical this will actually happen. She points to the state’s failing record with Sacramento’s Geographic Managed Care dental program saying, “very little attention is paid to the GMC side, very little oversight, very little enforcement.”

Aved says the root of the problem is the low payments to dentists. She says for every dollar dentists spend on care for Medi-Cal patients, they get reimbursed 10 to 20 cents. And this has led many to drop out of the program altogether.

“Quite honestly, and I know this is the wrong economic environment to say this, but you have to pay an equitable rate,” Aved says.

Aved says without increasing payments you can’t fully fix Sacramento’s program. And she says there’s a bigger picture here – these same problems could come up if a current state budget proposal is approved. It would expand dental managed care into 30 counties across the state.

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