Assembly member Richard Pan (D-Sacramento) knew the subject was a little out of the ken of the workforce committee, but that it was too important to be ignored.
"One of principles in looking at whether we have an adequate workforce is to make sure we can take care of our patients," Pan said. "We need to take care of the oral health needs of children, and that depends, in part, on availability of coverage, and payment for those services."
Pan, chairman of the Assembly Select Committee on Health Care Workforce and Access to Care, presided over a recent hearing on children's oral health in Sacramento County.
A recent report revealed that only 30% of Medi-Cal children saw a dentist in fiscal 2010-2011 in Sacramento County. In other recent years, the utilization rate was even worse.
Statewide, closer to 50% of Medi-Cal children saw a dentist last year. The difference in Sacramento is attributed in part to the county's payment model of geographic managed care in which dentists get a capitated rate for caring for a population in a certain area. Critics say there is little incentive for dentists to see more children since they get paid the same amount whether they see more patients or not.
"We are one of two counties that have this focus on geographic managed care rather than fee-for-service," Sacramento County Supervisor Phil Cerna testified. "It has been a pilot program now for 18 years, so it's time to move out of the pilot stage."
Cerna said there has been too much focus on which system to use. He said the focus in Sacramento County should be on outcomes and improving utilization rates.
"In 2008, we had 117,000 kids ages 0-20 that were eligible for Denti-Cal services, but only one-fifth of them received services," Cerna said. "That means over 93,000 kids were eligible for Denti-Cal and did not receive what they needed. …That's completely unacceptable."
The current rate of utilization in the county rose to about 31% last year, he said, "but that still means that 69% of eligible kids aren't getting services. The focus needs to be not on system change but rather what do our kids need? How do we increase utilization?"
Carrie Gordon of the California Dental Association, noting that the statewide 50% utilization rate is pretty low, said the state needs to have a dental director, someone to coordinate care and champion oral health issues.
"At a time when oral health has been decimated over the past few years, with the elimination of adult oral health as a [Medi-Cal] benefit, for instance, this is the time to do something [at a state level]," Gordon said. The idea of a dental director, she said, is "to bring someone to the state with public health background, and a dental degree, so they can help shape these issues."
While the overall numbers of providers are large, there is a shortage of dental professionals in some parts of California, Gordon said.
"There are 37,000 dentists in the state, and 20,000 hygienists, but those statistics don't tell the whole story," Gordon said. "There are areas in the state where there are extreme shortages of dental professionals. You can't just put more providers into a system that's broken. You need to bring the plans, the payers and the recipients together to solve this issue."
In part, that was the point of the hearing, Pan said, and another good argument for the appointment of a dental director for the state.