Oral emergency

As National Children’s Dental Health Month comes to a close, low-income families in California face a mixed bag of oral-health news.

Good news: Officials report strong positive results from outreach efforts to the 860,000 children in the Healthy Families state insurance program.

Bad news: California is preparing to shift those children to Medi-Cal, which already faces shortfalls in the quality of care and number of providers.

The change in insurance coverage is slated for Sept. 1. At that point, 5 million children—around half of the state’s population of children—will be part of the Medi-Cal system.

Medi-Cal, the state’s Medicaid plan, reimburses physicians and dentists at among the lowest rates in the nation—and a lower rate than Healthy Families, the state’s Children’s Health Insurance Plan. As a result, parents with only Medi-Cal as their insurance tend to have a difficult time finding private practices—in pediatrics and dentistry—that will accept their children.

That has a significant impact on these families. According to a recent report from The Children’s Partnership (TCP), a national advocacy organization, around half of the under-21 enrollees in the Medi-Cal dental program Denti-Cal received no dental check-ups or treatment in 2011.

As report author Jenny Kattlove told Southern California Public Radio station KPCC: “Families are really struggling to access dental care. … Oftentimes they have to wait months even just to get an appointment and/or they have to travel great distances to get care.”

When children don’t get that care, particularly preventative treatments, tooth decay may develop into a chronic condition that can become serious enough to warrant a trip to the emergency room.

“California’s Medi-Cal dental system is already struggling to serve children and is unprepared for what’s to come,” Wendy Lazarus, founder and co-president of The Children’s Partnership, said in a news release announcing the report. “California’s kids deserve real access to quality dental care—not a false promise of it.”

The TCP report (titled “Fix Medi-Cal Dental Coverage”) says that in 2005, the last year for which data were available, around one in four children, from newborns to 11-year-olds, had not been to a dentist—ever. Not surprisingly, nearly three in four experienced tooth decay by the time they reached third grade.

“A key reason children enrolled in Medi-Cal do not access dental services is the limited number of dentists who will treat them,” the report continues. “In fiscal year 2009-2010, only 35 percent of dentists in California treated children enrolled in Medi-Cal. Of those, only a quarter saw 80 percent of the children, demonstrating that there is a limited supply of dentists willing to treat significant numbers of children.”

TCP makes a number of recommendations to state officials, including:

• Educate families about their dental benefits and how to access care.

• Address barriers—such as language, cultural, and transportation barriers—that families face in accessing dental care for their children.

• Target strategies toward particular populations of children who have difficulty accessing dental care, such as young children and those with special health-care needs.

• Improve reimbursement rates.

• Simplify the bureaucratic processes for dental providers to enroll and participate in Medi-Cal.

• Explore creative ways—such as teledentistry, new workforce models and school-based strategies—to connect children to care.

In terms of the recommendation’s “workforce models,” TCP suggests the state expand the roles of dental assistants and dental hygienists in areas underserved by dentists.

Finally, to oversee needed changes, the TCP suggests creating a statewide office of oral health.

“This is a unique moment in history when we have the opportunity and imperative to make a significant difference,” the report concludes. “If tapped into skillfully, the transition of children enrolled in the Healthy Families Program into Medi-Cal and the implementation of ACA [the federal Affordable Care Act] offer an opportunity to create new solutions that ensure all children in California—especially underserved children—receive the dental care they need.”

Medi-Cal officials may want to look to Healthy Families for guidance. California Healthline reports that the state’s Managed Risk Medical Insurance Board (MRMIB), which oversees the program, cites progress in dental measures.

Among the most promising findings:

• Around 90 percent of Healthy Families children who visited a dentist “for any reason” received a preventative treatment, such as fluoride or sealant, as part of the visit.

• Families gave their child’s dentist, the dental staff and access to dental care a higher rating in the 2011-12 survey than in the 2010-11 survey.

Interestingly, the MRMIB found, Latino children visited the dentist at significantly higher rates than other ethnic groups, while American Indian/Alaskan Native children received dental services at the lowest rate.

Janette Casillas, executive director of the MRMIB, told California Healthline that the annual survey had an interesting addition this time: “If they weren’t getting preventive services, we asked them why. And most families’ response is because they didn’t need it.” Instead, they tend to wait for children to have pain before going to the dentist.

“We will be pushing this really hard for our families in our program, the need for an annual visit,” Casillas continued. “We have run some pilot projects, where we have dental vans, or we have dental clinics on the weekends and evenings. And those have shown good results.”

Hopefully state officials are paying attention, as nearly a million children leave Healthy Families for Medi-Cal.

In the meantime, teledentistry—one of the recommendations of The Children’s Partnership—is getting a major trial run in the Bay Area. HealthyCal.org reports that 11 organizations are teaming up to offer remote evaluations by dentists for children and adults in need.

Under the pilot program, called the Virtual Dental Home Demonstration Project, patients will have their teeth examined by dental assistants and hygienists. Portable imaging equipment will scan the patients’ mouths; those scans, along with medical history and notes from the on-site providers, will be uploaded to a secure website. Dentists will review the files and suggest treatment plans, or make a referral to a local dentist for more complex cases.