In a move that affects millions of California students who rely on Medi-Cal for dental services, reimbursement rates for dentists who care for low-income children will be cut, the Department of Health Care Services announced Thursday.
Dental disease has emerged as an important factor in depressing school attendance and academic performance among low-income students, and advocates said the reduction in reimbursement fees will make it more difficult for students to obtain care. As it stands, half of children under age 21 enrolled in Medi-Cal’s dental program did not have a single dental visit in 2011, according to a January 2013 report by The Children’s Partnership, a nonprofit group that studies children’s dental health.
Dentists who accept Medi-Cal for children’s care will have their fees reduced by 10 percent starting next month. In addition, the state will apply the fee reduction retroactively to June 1, 2011 and seek to recover overpaid funds. Current Medi-Cal dental reimbursement rates in California rank near the bottom of the nation, according to the California Society of Pediatric Dentistry, and the number of dentists who take Medi-Cal payments is limited.
“It’s most unfortunate,” said Lindsey Robinson, president of the California Dental Association and a pediatric dentist in Grass Valley. “Dental caries is the most common disease of childhood, and the bulk of the disease burden is in underserved kids,” said Robinson. “These are the kids who are going to be impacted in a big way, because access to a dentist for treatment is going to be restricted.”
Update: The Department of Health Care Services disputed the idea that a reimbursement rate decrease would make it more difficult for children on Medi-Cal to receive dental services. The department has a federally approved monitoring plan to measure patient access to Medi-Cal dental services, said Norman Williams, deputy director of the Department of Health Care Services, and there are 15,281 active Medi-Cal dental providers with offices in all 58 counties. “If our access monitoring plan indicates that dental care access is insufficient for Medi-Cal members, we will take immediate action to address the problem,” he said. To improve the 50 percent utilization rate of Medi-Cal dental services by children, the department has strengthened outreach to Medi-Cal families and implemented provider performance measures, he said. “There are many reasons that some children don’t see dentists on a regular basis,” Williams noted, adding, “Our monitoring plan’s purpose is to ensure that these children have access to care.”
Dental problems keep California students out of school for an estimated 874,000 days a year, costing schools about $29.7 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, an ongoing statewide survey by the Center for Health Policy Research at UC Los Angeles. The study is still considered the benchmark for children’s oral health. To address student needs, schools have struggled to provide a dental safety net by establishing school-based dental care.
“If kids are not healthy, they are going to miss school and if they are in pain, it’s going to affect learning,” said Hedy Chang, director of Attendance Works, a nonprofit group that studies student attendance issues.
Exempt from the 10 percent fee cut are nonprofit pediatric dental surgery centers that provide “at least 99 percent of their services under general anesthesia to children with severe dental disease.” These centers serve children who have “rampant disease” or who are too young to be effectively managed without anesthesia, said Robinson from the California Dental Association. The services are valuable, she noted, but preventive dental care is crucial.
“Otherwise, we’ll never get on top of it,” said Robinson. “In my practice, it’s very disheartening to see these kids come in with an amount of decay that is almost entirely preventable.”
By the end of 2013, about 5 million children – roughly half of the children in the state – are expected to be enrolled in Medi-Cal, according to The Children’s Partnership. The rate reduction, which applies to many Medi-Cal services in addition to dental care, was approved by the state legislature in 2011 and signed into law by Gov. Jerry Brown as a cost-cutting measure. The implementation of the rate change had been stalled in court proceedings until June.
“The State’s decision means that families will face even greater hurdles getting care for their children,” said Jenny Kattlove, director of strategic health initiatives at The Children’s Partnership, “resulting in pain and suffering among children who go without necessary care, expensive emergency room visits for preventable dental problems, and missed school and work due to dental problems.”
Efforts to reform the Medi-Cal system for children’s dental care have failed, said Ray Stewart, executive director of the California Society of Pediatric Dentistry. “The Denti-Cal system in California is broken beyond repair,” said Stewart. “I think the future is very grim and the big losers are children.”