California Isn’t Making the Grade on Kids’ Dental Care

A new report on the well being of California’s children gives the state a report card that definitely wouldn’t please mom. On nine different kids’ health measures, the organization Children Now gave the state C’s and D’s, with the exception of a lone B+ in the category of “health insurance.”

Nestled in that cluster of D’s is the category of “oral health.” A quick glance at the statistics suggests why: Among California’s 2- and 3-year-olds, 37% have never been to the dentist, according to the report. By kindergarten, 28% of kids have untreated decay, and that can lead to poor school performance and missed days. Dental woes caused California kids to miss an estimated 874,000 school days a year, at a cost to schools of more than $29 million a year, according to the Children Now report.

Without preventive dental care, problems are left untreated and kids can end up in the E.R. According to Children Now’s analysis, kids on Denti-Cal (the state’s Medicaid dental benefit for children) rack up more than 26,000 E.R. visits a year for dental problems, at an annual taxpayer cost of $4.5 million. Nationwide, more than 830,000 people were seen in the E.R. for tooth-related problems in 2009. Dental-related fatalities are rare, but not unheard of.

Napa dentist Maryam Mohsenzadeh, who delivers care to kids via a mobile clinic, recently told the Napa Valley Register that “it’s not uncommon to see young patients with severe dental infections that require an emergency response. Some of these patients have never been to a dentist before or their parents haven’t established dental care habits at home. In many of these cases, Mohsenzadeh said, she will have to put the child — sometimes as young as 2 — under general anesthesia and perform emergency dental surgery … ”

So why are kids, especially those from low-income families, not making it to the dentist earlier and more often?

Dismal reimbursement rates are a big part of the problem for kids under Denti-Cal, the state’s fee-for-service Medicaid dental program that also used to cover adults until 2009 budget cuts. Kids on Medi-Cal are automatically eligible for dental benefits. (While Denti-Cal is used by most of the state, Sacramento County uses a managed-care Medicaid dental plan, as do some residents in L.A. County). California ranks near the bottom nationally when it comes to Medicaid reimbursement rates.

For example, Denti-Cal pays $15 for a child’s dental exam. That’s compared to a national average of nearly $23, according to a 2007 report. For comparison, dentists in the 75th percentile charge about $44 for such an exam, according to a nationwide survey of fees.

Adding insult to injury, Governor Jerry Brown and the legislature approved a 10% cut to Medi-Cal rates in 2011, further lowering Denti-Cal’s reimbursement rates.

Lower payments mean fewer dentists willing to see Medicaid patients: Only 25% of California dentists accept Denti-Cal members, according to the California HealthCare Foundation. That’s down from 2003, when 40% of dentists accepted Medi-Cal payments.

Children Now reports that “22 California counties have no pediatric dentists who accept Denti-Cal.” Statewide, there is one Denti-Cal dentist for every 700 kids, with only half of those dentists accepting new patients.

Even though they’re less likely (30% according to one estimate) to visit the dentist that their privately insured peers, low-income kids with public insurance are much more likely to need dental care. Data from 2010 suggest that low-income children are nearly twice as likely to develop cavities as their more affluent peers.

Of course reimbursement rates aren’t the only challenge. Families on Medicaid might not know their kids have dental coverage. They might not have transportation or can’t get time off work to get to a distant dentist, especially in rural areas. Parents just might not know how important routine dental care can be to their kids’ health and school performance.

For all these reasons, Medi-Cal kids aren’t getting to the dentist often enough. In 2011, an estimated 63% of Medi-Cal kids didn’t get a preventive dentist visit, according to the nonprofit advocacy group The Children’s Partnership, which ranks California in the bottom 10 states for getting dental care to Medicaid children.

Even worse, it appears the problem of too few dentists for too many kids is set to worsen as approximately 875,000 additional kids transition from Healthy Families to the state’s expanded Medi-Cal system. In 2014, nearly half of all children in California will be covered by Medi-Cal dental benefits, according to Children Now.

Last year, the state’s Department of Health Care Services tried to recruit more dentists who would accept Medi-Cal payments. But the effort didn’t net as many dentists as hoped, according to Jenny Kattlove, director of strategic health initiatives at The Children’s Partnership.

Despite the surge in Medi-Cal enrolled kids, there’s no sign of a relief corp of dentists coming over the horizon to match supply with added demand.

“We can only assume the number of dentists who take Medi-Cal will continue to decrease, leaving kids in dire straits,” Kattlove said in an interview, citing low reimbursement rates, burdensome paperwork, and some dentists’ aversion to seeing kids under the age of 3.

Next post: A look at new legislation that attempts to bring more dental care to young kids and underserved groups by way of “teledentistry” and newly empowered dental assistants.

Image by Sam Pullara via Flickr