Sonoma County’s dental care for kids seen as lacking

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There were only nine full-time dentists in Sonoma County willing to treat 19,396 children through the state’s Medi-Cal insurance program last year.

That amounts to one dentist for every 2,155 children, a ratio the California State Auditor deems insufficient, according to a recent report that found 27 counties either had too few or no dentists at all willing to treat children on Medi-Cal.

Local health care experts argue that the lack of dental health services for Medi-Cal patients is even worse now since President Barack Obama’s Affordable Care Act, among other things, greatly increased the number of county residents on Medi-Cal.

“We’ve doubled the number of Medi-Cal enrollees, but we didn’t double the number of dentists willing to see those kids and adults,” said Pedro Toledo, acting CEO of the Petaluma Health Center and a member of the Sonoma County Oral Health Task Force.

Toledo said the report focused on children because the state eliminated dental services under Medi-Cal for adults in 2008. Adult dental services were reinstated this year.

The report, which was released earlier this month, blasted the California Department of Health Care Services, which is responsible for administering Medi-Cal, the state’s version of the federal Medicaid program.

The auditor found that the state agency has failed to adequately monitor Medi-Cal’s dental services, and as a result may be unaware of its shortcomings. The report also found the agency does not collect specific data needed to meet state and federal reporting requirements and has not enforced certain Medi-Cal contract provisions aimed at increase dental service utilization.

Reimbursement rates to dentists averaged just under $22 for 10 or the most frequent dental procedures covered by Medi-Cal. That rate is only 35 percent of the national average for the same procedures in 2011.

The Department of Health Care Services said the agency agrees with most of the findings in the State Auditor report and has already begun to take corrective action.

The report found that in 2013 there were 11 counties in the state that had no dental providers who were willing to accept new Medi-Cal patients under 21. Another 16 counties, including Sonoma, had dentist-to-patient ratios worse than one dentist for every 2,000 young people covered by Medi-Cal, a threshold the state deems as inadequate.

In Mendocino County, last year there was only one dentist accepting new Medi-Cal insurance for 6,159 patients under 21. Lake County had only one dentist for 4,410 young Medi-Cal patients.

Suzie Shupe, executive director of the Sacramento-based California Coverage & Health Initiatives, a statewide outreach and health care enrollment network, said the report reinforces criticism health care advocates have been levying against Medi-Cal for years.

“I applaud the Office of the State Auditor for doing such a clear, straightforward and comprehensive analysis,” Shupe said.

Shupe, who lives in Sonoma County, said Medi-Cal’s shortcomings in dental services, its inefficiencies and inadequate provider network, are issues “we can now talk about openly and work on fixing.”

Shupe said it is difficult to put an exact figure on how many dentists would be adequate to meet the needs of Sonoma County’s nearly 20,000 young people on Medi-Cal. She called the state’s threshold of one-to-2,000 “arbitrary.”

“Huge efforts need to be put in place to recruit and encourage dentists” to serve underserved communities, she said.

Anthony Cava, a spokesman for the Department of Health Care Services, said the agency recognizes the need to expand dental services under Medi-Cal. He said the agency is engaging in an ongoing campaign to enroll new dental providers throughout the state.

“In addition, DHCS is in the process of moving forward with a plan to allow certain other allied dental professionals to bill for Medi-Cal dental services within the scope of their practice,” he said.

He said the agency is also developing a plan to allow for services to be provided via the Internet.

Many of the county’s nine dentists currently work at one of several health centers designated as federally qualified health centers. The designation allows the community clinics to receive an enhanced reimbursement rate under Medi-Cal.

Dental services provided by local health centers have greatly expanded in recent years.

The Petaluma Health Center, which employs four dentists at its current clinic, is scheduled to open a new medical campus in Rohnert Park that includes a 15-chair dental clinic.

“We’re hiring a pediatric dentist to see our youngest patients,” Toledo said, adding that five new dentists, including the pediatric specialist, will be hired.

“As time goes on, we’ll increase that capacity,” he said.

The Sonoma Valley Community Health Center, which opened its new facility on Highway 12 this year, is also slated to launch a brand new dental clinic. That clinic will have six dental chairs a staff of one full-time and one half-time dentist, said Cheryl Johnson, the health center’s CEO.

“We’ll be the only dental provider in the city of Sonoma that will see Denti-Cal and the uninsured,” Johnson said, referring to Medi-Cal’s dental service.

Johnson said the reason private dentists will not take Medi-Cal is obvious.

“When your Denti-Cal rates haven’t increased since 2010, you’re not going to have very many providers outside (federally qualified health centers) who want to take Denti-Cal patients,” she said. “Dental services are not cheap. Most private practice dentists have to be able to make ends meet and make a profit and that’s difficult to do with the Denti-Cal reimbursement rates.”

Shupe said the state cannot simply rely on dental services at health centers to meet the growing demand.

“It can’t just be the responsibly of the health centers,” she said. “The state needs to look at private dentists as an important part of meeting the network adequacy requirement.”

Cava said DHCS will provide periodic updates to the State Auditor that describe the progress made on its corrective action plan.

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

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