Children Underserved by Denti-Cal, According to New Study

by Bob Norberg, California Healthline Contributing Reporter

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Denti-Cal, the federally subsidized dental care program serving five million school-aged children in California -- about half the state's children -- is falling short of providing the necessary care, according to a new study by Children Now, an Oakland-based not-for-profit that promotes health and education for children.

For more coverage on the study, see last week's daily news story.

As an average in California, there is only one Denti-Cal pediatric dentist for every 700 children, according to the report.

At the worst end of the dentist distribution, four counties have no Denti-Cal dentists for children whatsoever and four counties have only one Denti-Cal dentist for each 1,000 to 3,100 children. These new findings released earlier this month are similar to data reported in studies going back several years, said Eileen Espejo, Children Now's director of media and health policy research.

"They are underserved," Espejo said, referring to children who rely on Medi-Cal for their dental treatment. "There are a lot of factors. We have to make sure that parents are properly informed, that dental care is paramount in formative years."

"That is absolutely a concern," said James Stephens, a Palo Alto dentist and president of the California Dental Association. "We have been focused on this for many years. There are barriers to care for the underserved population. Children are desperately underserved in California."

Denti-Cal, the Medicaid service for dental care for California children and adults, recently absorbed 863,000 kids from the state-subsidized Children's Health Insurance Program, which was phased out.

That shift resulted in a drop in reimbursement rates to Denti-Cal pediatric dentists for those beneficiaries.

"California continues to be at the bottom in terms of Medicaid reimbursement," said Jessica Mindnich, Children Now director of research.

Mindnich said the report took several months to complete and covers the 2011 year, compiling data from public information requests to private insurance companies, the California Department of Health Care Services, and the California HealthCare Foundation, which publishes California Healthline.

Among the key dental findings in the new study:

  • There is only one Denti-Cal dentist for each 700 children on average in California;
  • In poor and rural counties, the rate is less. There is one Denti-Cal dentist for every 1,076 children in Del Norte, for 1,102 children in Fresno, for 2,856 in Merced and 3,178 children in Glenn counties;
  • There are no Denti-Cal dentists at all for children in Alpine, Sierra, Mariposa and Yuba counties;
  • Denti-Cal reimbursements are about one third of what dentists receive from private insurance policies, leaving California at the bottom of subsidized reimbursements compared to other states;
  • Lack of proper oral care for children has resulted in 26,614 emergency room visits, at a cost of $4.5 million, and resulted in 500,000 children missing school, at a cost to schools of $30 million.

"When you have half the kids in the state on Medi-Cal, that is just a jaw-dropping number," Espejo said. "There is a lot of money to be saved and a lot of children's teeth to be saved as well."

Increasing Denti-Cal reimbursements that were cut 10% by the California Legislature would be an incentive for dentists to be trained to treat children and purchase the necessary equipment, Espejo said.

Jenny Kattlove, director of strategic health initiatives for the Children's Partnership, said transportation is also a barrier to dental care for California children.

 "We need to think of creative solutions, bringing care to where children are at school sites and using telehealth technology," Kattlove said.

The Children's Partnership is supporting AB 1174 by Assembly members Raul Bocanegra (D-Pacoima) and Daniel Logue (R-Sacramento) which would approve Medi-Cal reimbursements for tele-dentistry. The bill, making its way through the Assembly, would emulate the Virtual Dental Home pilot project at the University of the Pacific's School of Dentistry.  Under the program, dental hygienists and dental assistants see children at elementary schools and Head State Centers, where they take X-rays, radiographs and pictures that are transmitted to dentists who diagnose and prescribe treatment.


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