Crisis in dental care for Sonoma County, beyond

Santa Rosa dentist Randy Nguyen still remembers all the closed doors he encountered whenever he tried to see a dentist, optometrist or primary care doctor.

Nguyen, who emigrated from Vietnam when he was 15, enrolled in Medi-Cal, the state’s low-income medical insurance plan, while studying mechanical engineering at UC Davis.

He said he had a difficult time finding specialists, especially dentists who would accept Medi-Cal reimbursement rates, which to this day cover only a fraction of the cost of caring for dental patients.

When he became a dentist in 1996, Nguyen said he saw himself in every Medi-Cal patient who came in with a cavity.

“I could do the same thing, say ‘Forget it, I’m not going to take Medi-Cal,’ but who is going to help these people?” Nguyen said.

A state audit last year of Denti-Cal services found there were far too few providers to treat the estimated 19,396 children enrolled in the Medi-Cal dental program. The audit found that in 2013 there were only nine full-time dentists in Sonoma County willing to take new Denti-Cal patients.

Some 80 percent of Nguyen’s patients are covered by Denti-Cal. The other 20 percent are private pay or covered by commercial insurance.

It’s a delicate balance that must be maintained to cover the cost of doing business. To illustrate how low reimbursement rates are, Nguyen said the normal cost of treating a cavity is about $200 but Denti-Cal pays only $39.

“I need to work on my regular patients to stay afloat,” Nguyen said. “The reason that dentists in Sonoma County don’t take Medi-Cal is because the fee is so low.”

That fact is why Nguyen and other local dentists do not blame their peers for not accepting new Denti-Cal patients. Some dentists have reached that economic balance and cannot take on new Denti-Cal patients.

Other dentists provide their share of charity care, whether through treating existing low-income patients or through annual events where they open their doors and treat a host of local residents for free.

But the fact that so few private dentists and dental specialists are willing to accept new Denti-Cal patients is a testament to a crisis in a program that for local and state officials is becoming more difficult to ignore.

Last week, state lawmakers held a joint legislative hearing in Sacramento to discuss the findings of the state auditor, revealed in a scathing report.

At the hearing, Assemblyman Jim Wood, D-Healdsburg, criticized the Denti-Cal program for its failure to address the dental care needs of California children.

“In the five counties that I represent, a total of 12 providers are willing to accept new children under this program,” Wood said. “That’s a ratio of one provider to 3,000 beneficiaries.”

Wood, who is a dentist himself and a former mayor of Healdsburg, said a healthy ratio is around 2,000 patients per provider, “not 3,000 Medi-Cal beneficiaries.”

Last year’s audit found that less than 50 percent of the state’s children with Denti-Cal actually received dental care in 2013, and that the program’s reimbursement rates for the top 10 dental services for kids are only 35 percent of the national average.

The problems forced local dentists and dental specialists to make tough choices, limiting the number of Denti-Cal patients they see or simply not taking any more new ones.

Last week, a group of local orthodontics practices in Sonoma, Mendocino, Lake and Napa counties announced that they would soon be accepting Denti-Cal for orthodontic services. The practices, owned by Santa Rosa orthodontist Rael Bernstein, are: Santa Rosa Orthodontics, St. Helena Orthodontics, Clearlake Orthodontics and Wow Smiles, a brand new practice opening soon in Petaluma and Ukiah.

Bernstein, for the time being, will not take Denti-Cal at his main orthodontics practice on Montgomery Drive in Santa Rosa because he does not have the capacity to do so, said Zachary Hemmer, CEO of Bernstein’s group of practices.

“We’re not satisfied with access to care for Denti-Cal patients,” Hemmer said. “There are very few alternatives and no alternative in a private office setting.”

Earlier this week, at the group’s Santa Rosa Orthodontics offices on Marlow Road, Jason McCallister of Santa Rosa brought in his 9-year-old stepson Alex Benavides to have the wire in his braces removed prior to a check-up with his dentist.

McCallister, whose stepson is on Medi-Cal, said he pays $100 a month for the orthodontics work Alex receives, a fee he called “very affordable.” He said he was happy to hear that he’ll be able to use Denti-Cal to pay for Alex’s braces.

“That will be even better,” he said. “It’s a real good place to take him.”

Sergio Monraz, a Windsor dentist and spokesman for the Redwood Empire Dental Society, or REDS, said that not every child on Denti-Cal will be able to qualify for orthodontics treatment because of strict eligibility requirements.

Monraz, who recently re-enrolled in the Denti-Cal program, said most dentists in the county would like to treat more Denti-Cal patients but the low reimbursement rates make it “very prohibitive.”

Walt Weber, president of the California Dental Association, pointed out that reimbursement rates have not increased in the past 15 years. What’s more, he said, the state implemented a 10 percent cut in rates in 2013; pediatric medical was exempted but not pediatric dental services.

“In fact, five counties have no Denti-Cal providers and 11 counties do not have any accepting new patients,” Weber said in an email, citing the state auditor’s report of the state of Denti-Cal services, which he referred to as “abysmal.”

“The audit makes it very clear that the Denti-Cal program needs substantial improvements in order to provide timely access to care for patients,” he said.

Monraz said that if the state increased Medi-Cal rates by 10 or 20 percent, more dentists would accept new Denti-Cal patients.

The state Department of Health Care Services said Thursday that it is actively working to address issues raised about Denti-Cal deficiencies. One avenue currently being considered is targeting funding for new providers who agree to dedicate part of their practice to Medi-Cal patients, said Mari Cantwell, chief deputy director of health care programs for the state Department of Health Care Services.

The initiative would be included in the department’s latest draft of the state’s 1115 Medicaid waiver, which gives states the flexibility to test new ways of financing and delivering Medicaid.

“Also, we are hoping to complete by this July a thorough analysis of access to dental care and the adequacy of reimbursement rates,” Cantwell said in an email.

She said review of the analysis would not be completed in time to implement rate increases in the current budget process, “but the results of the review could be used for future budget estimates.”

Cantwell pointed out that any changes would have to be approved by the federal and state officials and agencies.

Cantwell said that her department conducted a dental provider survey last November and December that included questions about providers’ participation in Denti-Cal. The results of the survey will be made public soon, she said.

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.