Dental Group Warns of Provider Crisis for Special Needs Oral Care Patients

by David Gorn

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Medi-Cal patients with special needs are finding it nearly impossible to get access to dental care in the hospitals where they need it, according to representatives of the California Dental Association.

"Inadequate Medi-Cal reimbursement rates for hospital room, anesthesia fees and dental care have forced many facilities statewide to either cut or discontinue dental services for special needs patients," said a written statement released yesterday by the California Dental Association.

"Special needs patients need to be asleep in an [operating room] to have any work done," said Katherine Foster, a Sonoma County pediatrician who helped found a dental surgery center in Windsor. "And the dollars in the Medi-Cal dental plan just aren't enough to cover expenses."

Autistic patients have difficulty sitting still and cooperating to have dental work done, Foster said, and that means they need general anesthetic in a surgery setting.

"They have to go to an OR and that's where the access stops.

It has dwindled down to a very few spots that still do this," Foster said.

The access issue will become more severe July 31, Foster said, when Sutter Memorial Hospital in Sacramento stops accepting Denti-Cal special needs patients.

"This has been coming for a long time," Foster said. "But now it's a crisis because hospitals have now realized the Denti-Cal reimbursement does not cover their payroll costs."

According to a written statement from Norman Williams, deputy director of public affairs for the Department of Health Care Services, the state is doing something about it.

"Last Friday, DHCS staff met with Sutter Health's Regional Manager of Community Benefits, Holly Harper, and Wellspace Health's Jonathan Porteus. Sutter indicated it is phasing out all hospital dentistry business regardless of payment source.  During the discussion, Sutter confirmed it will close Capitol Pavilion on July 30 and Memorial on August 31, honoring only currently scheduled appointments and refusing any new patient business," Williams said in a statement. 

"DHCS will meet with the Medi-Cal dental managed care plans, Department of Developmental Services, and with interested stakeholders to identify alternatives for the services that members previously received from Sutter. DHCS will work diligently to ensure that Medi-Cal patients can continue to receive medically necessary dental surgery services," Williams said.

Foster estimated about 20% of the roughly 270,000 patients in the 21 regional centers statewide need general anesthesia to get dental work done -- more than 50,000 people across the state.

"Many people have been waiting a year for an operating room spot," Foster said. "Dentists have stopped sending us new patients because the others haven't been able to see anyone."


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