Medi-Cal will partially restore dental benefits to three million low-income California residents on May 1, but it could be too late for some individuals whose oral health has deteriorated significantly since the benefit was cut, KPCC's "KPCC News" reports.
Medi-Cal is California's Medicaid program (Florido, "KPCC News," KPCC, 2/3).
In 2009, state officials cut Medi-Cal services for individuals in rural and other underserved areas, including eliminating coverage for adult dental care.
The California Association of Rural Health Clinics and a community health center in Kings County sued the California Department of Health Care Services and state officials over the cuts, alleging that the Medi-Cal changes conflicted with federal law. A court order reinstated the coverage in October 2010.
The state resumed payments for such services until May 2011, when it received CMS approval to eliminate coverage of benefits considered optional under Medi-Cal.
In July 2013, the 9th U.S. Circuit Court of Appeals ruled that cuts made by state officials "impermissibly eliminate[d] mandatory services from coverage" (California Healthline, 7/8/13).
Gov. Jerry Brown's (D) FY 2013-2014 spending plan included a total of $93.9 million over two years to help partially restore Denti-Cal benefits for adults. Denti-Cal is the Medi-Cal dental program (California Healthline, 8/7/13).
Details of Restored Benefits
The restored benefits will include coverage for:
- Full sets of dentures; and
- Root canals.
California Dental Association President James Stephens said the organization is "delighted" with the decision to restore Denti-Cal benefits but expressed concern over the state's decision not to cover:
- Gum treatment; and
- Partial sets of dentures.
According to advocates, failing to cover gum treatment could have significant effects on patients with diabetes who often have chronically enflamed gums. In addition, not offering coverage for partial dentures could encourage patients with a few missing teeth to have more teeth pulled in order to qualify for a full set of dentures.
A spokesperson for state Senate President Pro Tempore Darrell Steinberg (D-Los Angeles) said it is too early in the budget process to decide whether to advocate for restoring additional dental coverage.
Benefits Too Late for Some
Meanwhile, Frazier Moore, the dental director at Watts Health Center in Los Angeles, said some patients had to forego proper dental care when the benefits were cut and instead chose to have problem teeth pulled. Moore added, "[T]his puts us in a downhill slide for these patients to become what is commonly referred to as a dental cripple."
In addition, Irving Lebovics, dental director at Cedars-Sinai Medical Center, said dentists completing their residencies have missed out on training experience they normally gain treating Denti-Cal patients ("KPCC News," KPCC, 2/3).