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Medi-Cal

Friday, January 18, 2013

Report Finds State Facing Dental Crisis for Medi-Cal Children

California is facing a shortage of dentists willing to accept Medi-Cal beneficiaries as the state prepares to transition nearly one million children to Medi-Cal dental programs, according to a report from The Children's Partnership, KPCC's "KPCC News" reports.

Medi-Cal is California's Medicaid program (O'Neill, "KPCC News," KPCC, 1/17).

Background

By Sept. 1, the state aims to shift about 863,000 children from Healthy Families to Medi-Cal, which reimburses physicians at lower rates. Healthy Families is California's Children's Health Insurance Plan.

Diana Dooley -- secretary of the state Health and Human Services Agency -- said that the transition will help streamline and simplify government health care programs for California children (California Healthline, 12/5/12).

Main Findings

The report found that children currently enrolled in Medi-Cal are not receiving needed dental care.

According to the report, nearly half of beneficiaries under age 21 who are enrolled in Denti-Cal -- a Medi-Cal dental program -- did not receive a dental check-up or treatment in 2011.

The report found that a major factor in the lack of dental care was that relatively few dentists accept Medi-Cal patients (The Children's Partnership release, 1/18).

Recommendations

The report recommended that state officials:

  • Ease enrollment processes for Medi-Cal dental programs;
  • Expand the roles of dental hygienists and dental assistants so they can provide care in regions with fewer dentists;
  • Improve efforts to educate families about the availability of dental benefits; and
  • Raise Medi-Cal reimbursement rates for dentists ("KPCC News," KPCC, 1/17).

Reader Comments:
  • 3
  • 01/18/2013
  • bruce whitcher

Although San Luis Obispo County admittedly has very few dentists who accept Denti-Cal, there are 3 clinics that do. Two are FQHC's that get federal matching $. All place emphasis on treating kids and employ dentists who are trained to treat small children. The adults are the ones who are out of luck, with dental benefits limited to extractions.

All of the issues raised in the report are valid. Denti-Cal is not provider friendly and rates are well below costs. Moving kids from Healthy Families to Denti-Cal, although a cost saving measure, will cause many providers to drop out.

Dental services are costly to provide. You need a highly trained workforce, expensive equipment and facilities, and the treatment volume is low because of the treatment time needed as opposed to fast turnaround for medical visits.

There is no easy answer to this problem. Throwing $ at it will help some, but seems unlikely to happen.

  • 2
  • 01/18/2013
  • Gregory Beamer

The rest of the story is that the State has been overly aggressive in the last couple years, coming in to practices that they considered "clean" a couple of months prior, hunting for anything that is out of line with their manual, and they have been strong-arming dentists. One of my clients was told "if we find ANYTHING out of line, we will shut you down and you are going to jail". How would you like that kind of attitude? Doesn't that make you want to run right out and become a provider? And when they hit you with a fine, once you pay, they turn right around and have asked some of my clients if they want to continue being a provider! Most dentists are scared as hell to even get close to Medi-Cal - it simply is not worth it. So, all you bleeding heart liberals - you voted for the folks running the show - you want to make everyone dependent on the State. So streamline the system, cut out the crap, and pay the dentists to do the work.

  • 1
  • 01/18/2013
  • Gregory Beamer

First, it takes about six months to get through the process to become a Medi-Cal provider. You have to have a special provider number to take the insurance. Second, everyone that works for you as the owner of the practice has to have their own number - and the practice has to have a number of it's own. In short - it is a tough process, and then there is the rest of the story. The system pays so little that you have to do a large volume of patients to even think about breaking even, much less make a profit. So most of the facilities are in lower rent areas, require larger square footage, more staff, etc. vs. a small private office. Most doctors have to prequalify their treatment, so the patient winds up coming back twice. This is because some take advantage of the program and commit fraud, so everyone pays.



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