Recent controversy over dental services in Sacramento County came to a head at an Assembly budget subcommittee hearing yesterday. The root of the problem is the county's children's dental care program, organized as a managed care pilot project that has been plagued with access problems over its 18-year history.
In fiscal year 2010-11, about 31% of the children eligible for dental care in Sacramento County actually saw a dentist (compared to a statewide average of about 50%). It is the only county in the state with a mandatory managed care dental program, which pays a per-person, capitated rate, whether beneficiaries receive dental care or not.
State legislators are considering changing that system to allow a voluntary option for beneficiaries to switch to fee-for-service. State health care officials are asking to keep the current system, with some major reforms to boost those low utilization rates.
"We want to improve the system we have today," said Toby Douglas, director of the Department of Health Care Services. Douglas said his department plans to aggressively monitor utilization rates, and is launching an outreach program, as well.
"We're creating a flier for families about the importance of getting dental care for young children," Douglas said, adding that the effort would then be followed up by phone calls to attempt to reach parents of eligible children. "And that outreach would be on the provider side, as well," he said.
In addition, the department is creating incentive benefits to increase utilization, Douglas said.
Those attempts at reform, though, fell on skeptical ears.
"This approach hasn't worked, and it has caused considerable frustration," said Assembly member Richard Pan (D-Sacramento). Some providers were so frustrated by the current system they found it was cheaper and easier to just offer dental services for free, Pan said.
"When free is easier than going through the system," Pan said, "then there's a problem. Clearly, there is a tremendous need for overhaul."
Douglas pointed out that creating a countywide fee-for-service system would bring its own logistical and accountability problems.
"We believe that strengthening managed care is the right thing to do," Douglas said. He added that the department would need "three or four months" to see if the outreach and other measures affect utilization rates.
"We want to see if that approach works, and if it doesn't, then we can look at a voluntary fee-for-service component," Douglas said.
Assembly member Roger Dickinson (D-Sacramento) didn't like that idea.
"Up till now, it's been a failure," Dickinson said. "We know what our experience has been. It has been a longstanding problem."
Once the media and legislative attention ebbs, Dickinson said, there would be little pressure to improve the system.
"My concern is that we'll go another year and be dealing with the same thing," Dickinson said. "What we have is not tolerable as it stands now."
The Assembly Budget Subcommittee on Health and Human Services approved a motion on a 3-0 vote to offer a voluntary fee-for-service option. That trailer bill language will be included in legislative budget negotiations this month.