Frustration Boils at Denti-Cal Hearing

It’s not Jennifer Kent’s fault, but that didn’t stop the seething criticism of legislators on Tuesday at a joint legislative oversight hearing in the Capitol Building.

Kent, appointed seven weeks ago as the new director of the Department of Health Care Services that oversees the Medi-Cal program, testified at Tuesday’s oversight hearing of the Joint Legislative Audit Committee and the Senate and Assembly health committees.

At issue was a December 2014 state auditor’s report that showed more than half the state’s children in Denti-Cal were not getting regular dental care and that 32 of California’s 58 counties may have a dental access problem because of a dearth of providers.

“This report concludes that [the Department of] Health Care Services’ information shortcomings and ineffective actions are putting child beneficiaries at higher risk of dental disease,” the auditor’s report said. “Federal data showed that nearly 56% of the 5.1 million children enrolled in Medi‒Cal in federal fiscal year 2013 did not receive dental care through the program.”

That didn’t sit well with joint committee chairman Assembly member Mike Gipson (D-Carson).

“Access to dental care for low-income children is inadequate,” Gipson said. “With the recent increase in the number of children eligible for benefits, access to dental care will certainly get much worse, without an immediate fix. … Low utilization, low reimbursement rates, low provider participation. This is a formula for deficient and ineffective programs.”

After state auditors and legislators discussed the severity of the problem at length, Kent addressed them.

“I want to say, first and right out front, I have heard you,” Kent said. “…Those who have worked with me know that when I say I’m going to put my shoulder to the wheel and get some results and solutions to the problem, I’m usually pretty good at doing that.”

Kent said the audit was fair and that the department agreed with the results. The department has several monitoring efforts underway, she said, as well as working on the 11 Legislature-mandated monitoring standards the department will meet in an annual report.

Kent said she wants to create a dashboard for Denti-Cal that would be similar to the ones created for Medi-Cal managed care. Mobile vans will go to some counties to ease the dental-services demand. The department conducted a provider survey in November and December of last year and Kent said the results of that survey would soon be made public.

“Lastly is … the new 1115 Medicaid waiver,” she said. “One of the components is working to identify additional dental providers and to either pay them an incentive to take additional Medi-Cal patients or if their practice is closed to Medi-Cal, could we get them to open up those practices.”

Assembly member Jim Wood (D-Healdsburg) is a dentist. He said he hasn’t seen Medi-Cal patients for years but is still on the state list of Medi-Cal providers.

“We hear from beneficiaries that it’s not working very well,” Wood said. “We hear from providers that it’s not working very well. We heard from the California State Auditor that it’s not working very well. You’ve agreed with 23 of the 24 recommendations. And to me that feels like plugging holes in the ship and trying to keep the whole thing afloat.”

He said the state needs to figure out what’s fundamentally wrong with the program and fix it.

“Can we be delivering care differently?” he asked. “What would be an ideal program?”

Sen. Richard Pan (D-Sacramento) was clearly frustrated with hearing about low utilization rates in Denti-Cal yet again.

“I have to admit, I’m going to be a little less patient than my colleagues,” Pan said. “I think it’s been way too long since we’ve done something. I’ve seen too much suffering, I’ve seen too many children suffer. I’m not sure I can stand anymore. This department needs to change.”

The department was required by law to submit a report on Denti-Cal utilization, Pan said, and it just never submitted that report.

“Regarding the report, there was a violation of state law,” Pan said. “It’s great that we’re now going to change that. But what should be the consequence if there’s once again a violation of state law like this, what should happen? … It’s been state law for a long time, and I know … you’re the new director, but what should be the consequence? What should we do about it?”

“Fair question,” Kent said. “It is never either comfortable or pleasant to have a legislative hearing like this and to be called in and asked really hard questions. I know the reports weren’t done, and that’s not an excuse and I’m not making excuses. So when I say we’re going to put them on track … we’re going to do them because the law says that.”