In a marathon four-hour hearing last week, the Little Hoover Commission listened to a sizable mountain of details about the failures, challenges and possible changes for the state’s Medi-Cal dental program, known as Denti-Cal.
“The Denti-Cal program has been neglected for decades and is broken,” said state Sen. Richard Pan (D-Sacramento), who testified before the Little Hoover Commission at a Capitol Building hearing Thursday.
“Dental problems are the most chronic condition for children and certainly one that’s preventable,” Pan said. “But what we have is a system with poor access. And of course if you don’t have access, that drives down the quality of care.”
Pan said he remembered a hearing he attended in 2010 when the California First 5 Commission had come out with a report that only 20% of Medi-Cal children received any dental care. He said not much has changed in terms of access, quality and oversight since that time.
But it was an event he attended last spring that left a more lasting impression, he said. A dental fair offered free care at the Sacramento Fairgrounds, where thousands of people lined up for free dental work.
“It was an amazing event,” Pan said. “But at the same time many of the patients waiting for [care] had Denti-Cal.”
Pan paused for a moment to recall that day. “I saw lines of people standing outside in the hot Sacramento sun for hours, all to get access to dental care,” he said, “and many of them with Denti-Cal. What’s wrong with that picture?”
That’s what half a dozen presenters and the Little Hoover Commission members were there to hash out. Many presenters pointed out that with expansion of Medi-Cal half of the state’s children now are in that program, along with one-third of all California adults.
Rene Mollow, deputy director of health care benefits and eligibility at the Department of Health Care Services, which oversees the Medi-Cal program, said the department has worked closely with the state auditor to identify and implement changes. She said the department is having a “robust” dialogue with stakeholders to improve the Denti-Cal system.
“Part of the challenge we have is it does take time in terms of making these changes,” Mollow said. “But we are committed.”
The pending federal 1115 Medicaid waiver proposal currently being negotiated with CMS officials has a Denti-Cal component within it, she said, to attract more dental providers to the program.
In addition, the department plans to pursue teledentistry, greater use of mobile dental vans and has been running an outreach campaign to get more dental care to children up to age three.
“Right now we are evaluating the efficacy of that campaign,” Mollow said.
She added that the 44-page form dentists need to fill out to become Medi-Cal providers is being reviewed and likely amended.
The discussion at the hearing inevitably turned to dental provider rates, which are among the lowest in the country.
“Rates are 31% of commercial coverage here in California, which really has a big impact on dentists,” said Nicette Short, director of public policy at the California Dental Association. “That’s a tremendous difference and that has a big impact.”
Another big step, Short said, would be to get a more accurate number of dental providers. State officials have said the number of providers has remained roughly the same in the past year, but Short would beg to differ.
“We think the statistics we have [from the state] are flawed,” Short said. “For one thing, they show no ability to capture the capacity of those providers.”
Even if it turned out there really are a relatively constant number of dental providers enrolled in serving Denti-Cal patients, there’s no sense of how many patients each of those providers sees, Short said.
Mollow said rates are one of the considerations in trying to revamp the Denti-Cal system.
“Rates are certainly a component of it,” she said. “But in terms of what that price point is, that’s a different discussion.”
Short also expressed provider frustration at the paperwork required to join the Denti-Cal provider network. “It takes six months to a year are the stories we hear and it just becomes mounds of paperwork,” she said. “It’s a hassle and a barrier to providers, and they just give up. There has to be a better way.”