Audit: Denti-Cal Failing To Serve Half of Children in Program

Denti-Cal has failed to provide adequate dental services to low-income children in California, according to a state audit released Thursday, the San Francisco Chronicle reports.

Denti-Cal is the dental program for Medi-Cal, California's Medicaid program (Colliver, San Francisco Chronicle, 12/11).

Background

According to the Sacramento Bee's "Capitol Alert," Denti-Cal serves about 2.7 million adults and children. That number could increase to 6.4 million as the result of the state's Medi-Cal expansion (Cadelago, "Capitol Alert," Sacramento Bee, 12/11).

Advocates warn that the increase in Medi-Cal beneficiaries could add pressure to the dental program, which already has been facing problems in recent years.

Audit Finds Access Issues

The audit found that Denti-Cal services have been provided to less than 50% of children enrolled in the program, largely because many dentists do not participate in the program because of low reimbursement rates (San Francisco Chronicle, 12/11).

Denti-Cal reimbursement rates for the 10 most commonly authorized procedures in 2012 averaged $21.60 -- about 35% of the 2011 national average (Audit summary, December 2014).

According to the Chronicle, those reimbursement rates have not increased since 2000 and were cut by 10% in 2013.

The audit also found that in 2013:

• Five counties with at least 2,000 children enrolled in Denti-Cal might not have had any participating dentists;
• 11 counties had no dentists who were accepting new Denti-Cal patients; and
• 16 counties appeared to have an "insufficient" number of providers accepting new Denti-Cal patients ("Capitol Alert," Sacramento Bee, 12/11).

Rural counties and those in far Northern California had the least access to Denti-Cal services, according to the Chronicle (San Francisco Chronicle, 12/11).

Inadequate Oversight of Denti-Cal Program

Meanwhile, the report criticized California's Department of Health Care Services for inadequate oversight of Denti-Cal, which it says "put[s] child beneficiaries at higher risk of dental disease" ("Capitol Alert," Sacramento Bee, 12/11).

The department also was criticized for not enforcing rules that require Delta Dental, the state's service contractor, to ensure that mobile services are available in underserved areas.

In addition, the audit found that DHCS has failed to comply with a state law that requires the department to review reimbursement rates annually in an effort to ensure that Medi-Cal beneficiaries have access to services (San Francisco Chronicle, 12/11).

Meanwhile, the report also noted that the state lacks enough data to determine whether Denti-Cal is working effectively (HealthyCal, 12/12).

Recommendations

The audit made several recommendations to improve access to Denti-Cal services and DCHS' oversight of the program.

Among its recommendations, the report suggested that DHCS:

• Establish criteria for assessing provider participation in and beneficiary use of Denti-Cal;
• Develop strategies for identifying areas in which provider participation and beneficiary use do not meet the established criteria and take immediate action to resolve problems; and
• Direct Delta Dental to submit annual plans for rectifying access problems and to contract with additional organizations to provide extra dental services.

DCHS agreed with all of the auditor's recommendations, except for one that suggested the department establish provider-to-beneficiary ratios as performance measures for reporting. DHCS said that it disagreed with the recommendation because such measures are not required by state law (Audit summary, December 2014).