If California fails to qualify for $10 billion in federal stimulus money over the next 16 months for immediate budget relief — a likely scenario, according to the legislative analyst — Californians could pay higher taxes and suffer deeper spending cuts triggered by the new state budget deal. The cuts could eliminate nine of the 34 areas of coverage provided under Medi-Cal, California’s Medicaid program.
But it doesnât have to happen that way, according to dental health advocates who argue that cutting adult Medi-Cal dental services would be pound foolish and end up costing the state more money in the long run.
âI donât pretend to understand the analysis of how this stimulus threshold works,â said Wynn Grossman, executive director of the Dental Health Foundation and the Oral Health Access Council, âBut I do believe the Legislature did not intend to cut adult Denti-Cal when they agreed to the budget settlement. I believe that when they voted on the budget most recently, legislators were counting on federal stimulus money to keep Denti-Cal going.”
Of the nine Medi-Cal coverage areas threatened — including vision, mental health and audiology services — adult dental services might be hit the hardest, according to dental advocates as well as officials from the California Primary Care Association, which represents more than 600 not-for-profit community clinics and health centers.
The elimination of the adult Denti-Cal program could directly affect as many as three million adults along with an incalculable number of kids and other adults Medi-Cal doesn’t cover, according to dental advocates.
‘Not as Cut-and-Dried as Weâre Toldâ
The state budget agreement reached last month specifies that certain tax increases and spending cuts could be avoided if California receives at least $10 billion from the stimulus package for immediate budget relief.
Legislative Analyst Mac Taylor estimates California will receive almost $31.5 billion in federal stimulus money over the next two years, but only about $8 billion will be available for budget relief through 2010.
State Treasurer Bill Lockyer (D) and Finance Department Director Mike Genest will make the final call by April 1. The treasurer’s office has hired a consultant and will develop its own estimate.
State officials said the decision will be made strictly by the numbers without regard to policy or politics.
Joel Cohen, policy director for the Dental Health Foundation, is not convinced the issue is as cut-and-dried as state officials contend.
âI keep hearing that this is not a policy choice, that Lockyer is going by the letter of the law — is the money there or is it not,â Cohen said. âBut I think thereâs something going on here beyond just policy. Thereâs no such thing as being in government and not being involved in policy and politics.â
Cohen and Grossman point out that Gov. Arnold Schwarzenegger (R) âblue-penciledâ Medi-Cal adult dental services on several occasions during recent budget negotiations. âAnd every time, the Legislature put it back in,â Cohen said. âWell, now weâre in a situation where they might not be able to do that.â
Cohen said he wouldnât be surprised to see the soon-to-be-termed-out governor move some of the stimulus money — whether it totals $8 billion or $10 billion — into the general fundâs rainy day account.
âI think the governor is very much aware of what his legacy might look like a year from now,â Cohen said. âIn his last year in office he could look like a real whiz kid with money left over.â
The governorâs press office did not return calls seeking comment.
Dental Cuts Far Reaching
Dental advocates urge state officials to find some way to continue covering oral health for poor adults in California. The ripple effects of cutting adult Denti-Cal would be long-lived and widespread, according to some predictions.
âI donât want to minimize the impacts of cuts to other programs such as mental health and vision and hearing, but generally speaking, the adult dental cuts would be the most devastating of the nine,â said Chris Patterson, spokes person for the California Primary Care Association.
Patterson said that beyond the obvious health problems individuals without coverage will face, the financial ramifications could have a wide impact. Patterson said that for most of the stateâs clinics and health centers, Denti-Cal accounts for about 40% of the dental business, âsome a little higher, some lower.â
âMany clinics will not be able to sustain their dental programs without that income,â Patterson said.
Carmela Castellano-Garcia, president and CEO of OHAC and CPCA, said cutting adult Denti-Cal could have a negative impact on Californiaâs economy.
The California Primary Care Association has projected a loss of more than 20,000 jobs in California.
âEliminating adult dental services would definitely have an economic impact for most of our clinics,â Patterson said. âSome clinics have more developed services in other areas, but across the board, I think dental cutbacks would have the most significant impact.â
Patterson said that eliminating Denti-Cal benefits for adults also will affect children and adults who are not covered by Medi-Cal.
Grossman echoed that thought, saying that if adults “arenât participating in dental health, their kids probably wonât be either. This could have a very long-lasting impact on oral health in California.â
Among California children ages six to eight, about 55% have untreated tooth decay, more than twice the national average for this age group, according to the Oral Health Access Council. Minority kids have higher rates of untreated decay.