A Talk With The Head Of California’s Troubled Dental Program

By Ana B. Ibarra California Healthline

A damning report released earlier this month by a state oversight commission described California’s dental program for low income people as an “outright mess,” detailing its severe shortcomings and poor performance.

In a seven-month review, the Little Hoover Commission found that fewer than half the people eligible for benefits in the Denti-Cal program actually get dental appointments — in part because of a serious shortage of dentists. The commission found that most dentists in California don’t participate in Denti-Cal — a division of the Medi-Cal insurance program for low-income residents — because of its low reimbursement rates and administrative barriers.

On top of that, many California residents don’t know they are eligible for the program, according to the report.

Because of these problems, among others, “millions of Californians are going through life with rotting or missing teeth, debilitating pain, poor oral health habits and no preventative care,” the report said.

But Alani Jackson, chief of Denti-Cal for a year now, said the Little Hoover report only reinforced her agency’s determination to improve the program. In an interview with California Healthline last week. Jackson suggested her agency was not surprised by the findings and sought to emphasize her detailed plans for rectifying them, some of them already underway.

The transcript has been edited for length and clarity.

Q: Do you think the Little Hoover Commission report was fair? What are some of the steps you are taking to address its findings?

A: These are not new items for us overall and we think the items that matter the most are things the department is already ahead of and currently working on.

As the report mentions, we have been approved for the Dental Transformation Initiative, which gives us $750 million [state and federal] dollars over a five-year period to direct at a variety of areas to improve access to dental services, including preventive services, increasing utilization of services for kids, and establishing continuity of care for beneficiaries. It also allows the opportunity for up to 15 dental pilot programs, which gives the community the opportunity to come up with some ideas and be innovative and creative on how to address the prevention issues we are looking at.

Q: There is also a 10-year statewide Oral Health Plan expected to be announced in June. Can you provide any details of the 10-year plan? And how would it work in relation to the 5-year program you just mentioned?  

A: The statewide Oral Health Plan is still a proposal. It is led through the Department of Public Health and it’s basically a plan that proposes to the state its goal and objectives for oral health care over the next 10 years. Its focus is the expansion of preventive care but it is not tied to any resources or mechanisms to implement it – whereas the [Dental Transformation Initiative] is a five-year [federally]-approved plan with a finite amount of funding with certain objectives we are being held to.

We do believe that at the end of the day [the two programs] will complement each other and support each other’s goals. Both work to improve access and increase utilization. The only overlap would be in similar efforts toward prevention, and that’s not a negative thing.

Q: Beyond prevention efforts, what can your agency do now to address the more immediate problems identified in the report?

A: With beneficiaries, the focus is to make sure they are aware that they have dental benefits and how to access them. We do direct outreach to … counties that are below a certain percentage of utilization. We’ve sent mobile vans, for example, to reach some of the rural areas. Last year they went to five counties (Alpine, Amador, Calaveras, Mariposa and Merced) and rendered services to 274 beneficiaries, both children and adults.

For providers, we’re sharing information on how we’re streamlining our application process, the benefits of being enrolled, updates in the program that might attract them. Obviously, the Dental Transformation Initiative is a big issue and we’re hoping the new incentive programs will attract new providers and expand the capacity of current providers to see more Denti-Cal beneficiaries.

Last year we also started the 0 to 3 Outreach effort where we targeted children ages 0 to 3 who had not previously accessed services. Through that effort, 15 percent of the population in that age range who had never accessed services ended up accessing services after we sent mailers and had an automated phone call. That’s something we plan to continue.

Q: Many people are not even aware that they are eligible for dental benefits as part of their Medi-Cal coverage. How does this happen and how do you make them aware of the benefits?

A: When beneficiaries becomes newly eligible [for Medi-Cal], they receive dental materials along with the medical portion of their benefits package. They get information on how to access these benefits: phone numbers, websites. There are lots of attempts to make them aware and educate them on their dental benefits. I don’t know if everyone looks at their materials, and maybe the priority is on the medical side. I’m not sure, and maybe we’re not as clear as we need to be, so that’s something we can look into to find the best ways to communicate.

In addition, we’re working on medical and dental collaborations. There’s a pilot program in Los Angeles County where a physician can do an oral screening or provide fluoride and then also give them a referral to a [dentist]. We’re very interested to see how it plays out and how it will impact utilization and prevention.

Q: The report cites dentist shortages as one of the biggest issues with the Denti-Cal program. Can the legislature be prevailed upon to raise the rates California pays to dentists and other dental care professionals?

We are required to do a dental rate review study that we deliver to the legislature. It compares California to other states and their Medicaid populations — the top 25 procedures and the rates set for those procedures. Our way of relaying the comparisons [of reimbursement rates] is through our rate review study. That’s what we can do. Once we provide this information, it’s really up to the legislature how they choose to utilize that resource.

Q: Next month, 170,000 undocumented immigrant children will be eligible for full-scope Medi-Cal, including dental services. Will these children be able to get dental services in a timely manner?

A: Absolutely. They’ll be enrolled and provided with information on how to access services, as are all newly eligible children.

Q: How do you respond to a pending complaint by civil rights groups claiming that the program discriminates against 7 million Latinos in California because it provides them with an inferior level of care?

A: All 13.3 million beneficiaries are important to us, and it is our duty to provide them with the benefits they deserve and that we are required to provide.

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