State Expands Dental Coverage for Poor — But Getting Treatment Is Another Matter

Inside the cavernous main building at the Sacramento County Fairgrounds was a beehive of activity. But this was no county fair or concert.

Instead, hundreds of long, reclining dental chairs fill the floor, and 2,000 people wait for a turn. The sound of drilling buzzed the air, and the acrid smell of anesthetic permeated it.

It was free dental day – a special program run by the California Dental Association Foundation. "CDA Cares" took over the entire fairgrounds for this event in March, and 300 dentists were busy pumping in Novocain and making lame jokes to captive patients.

Across the broad hall, there was one station for filling cavities, one for root canals, another for extractions, yet another for dentures.

It looked like a sort of Dental Disneyland.

Rhonda Morse of Sacramento was among the patients. She camped out at the fairgrounds the night before the event.

"Got here at 7 o'clock last night," she said. "We slept outside. It gets crowded real fast."

That's because the need is so profound. Denti-Cal, the state's program of dental care for low-income Californians, including 5 million children, is in disarray. At a time when millions more have been added into coverage, it’s becoming harder to find dental care. The CDA Foundation estimates that 10 million Californians face barriers to dental care.

Morse knows this first-hand.

"It takes months to get in, then you get an appointment, and it takes months to get in again," she explained.

She said it would have taken her years of appointments to get the dental care she received in a single day at the fair.

"Coverage and access are two different things," said James Stephens, a Palo Alto dentist and former chair of the California Dental Association who volunteered for the Sacramento event.

The reason there's no access, he said, is because so few dentists take Denti-Cal patients -- because they lose money on every one of them.

"Fees have been cut in the program so much, they're not enough to create a viable provider network," Stephens said.

That network of providers is even thinner now, he said. So there are fewere dentists to serve even more people who have signed up since the state expanded eligibility rules.

George Maranon, an oral surgeon from Encino, was working on a tooth extraction at one of the fair stations for a 9-year-old boy with diseased gums. He said he'd rather volunteer his time than take Denti-Cal payments.

"There are Denti-Cal patients who I actually see in my practice for free," Maranon said. "Sometimes dealing with the state in terms of reimbursement can be more expensive than just doing it for free."

Just to get to the national average for provider rates, California would have to spend three times as much as it does now, at least another $100 million a year, according to Elizabeth Mertz, a dental sciences professor at UC San Francisco.

Beyond inadequate provider rates, there’s another huge challenge in the Denti-Cal system, Mertz said. Half of the state's kids are in Denti-Cal, and those kids desperately need preventive care.

"So you're talking about taking care of a large portion of the state's children," she said. "If those children grow up with dental disease, they're going to be adults with dental disease."

She said lawmakers could pass a dental health parity law, and that would put preventive dental health services on the same plane as other essential medical care.

"Because nobody's made it a priority from the top on down," Mertz said. "When you say something's essential but you make it optional, that's not sending the message that it's a priority."

The new director of the Department of Health Care Services, Jennifer Kent, has acknowledged the deficiencies of Denti-Cal and says fixing it is one of her top two priorities. The department is working on a plan now to restructure the program, but state officials haven't said whether or not that would include a boost in reimbursement rates.

In the meantime, the next free California Dental Association dental fair will be held in Fresno, in October.