The tooth of the matter

A year ago, Cari Martinez was finally able to get a partial denture, something she had put off for years because she couldn’t afford it—not to mention that she is terrified of dentists.

“I finally got the courage to go in,” she said Monday, sitting in her van outside the Chico Family Health Center, waiting for a friend who had a doctor’s appointment. “Now I feel like it’s all for nothing.

Martinez is just one among the millions of people in the state who are affected by state budget cuts eliminating dental services for most adults who receive health care through Medi-Cal, California’s version of the federal Medicaid program.

In February, the governor and Legislature eliminated nine Medi-Cal “optional benefits” in an effort to trim the state’s budget deficit, including adult dental, psychology, chiropractic, acupuncture, speech therapy, incontinence creams and washes, audiology, optometry and podiatry services, effective July 1.

“The thing that upsets me is the fact that when your teeth are bad, it can cause all kinds of illnesses,” Martinez said. “You can’t take away the dental from people. We are talking about major illnesses.”

The California Department of Health Services reports nearly 6.8 million adults and children in the state are currently on Medi-Cal. The state anticipates saving at least $110 million in the next fiscal year as a result of the cuts. Dental benefits being eliminated include comprehensive oral evaluations for new and existing patients, prophylaxis and fluoride treatments, treatment for complete and partial dentures, fixed prosthodontic procedures and implant procedures.

Essentially the only service still available under the adult Medi-Cal program, or Denti-Cal, as it’s called, will be “federally mandated emergency services,” or extractions, reported Reza Abbaszadeh, CEO at Access Dental, a clinic that accepts Medi-Cal.

Benefits will still be available to pregnant women, children and adults under 21, as well as those living in licensed nursing homes.

“There’s a ton of people who are going to be affected,” said Melvin Sage, dental director at Northern Valley Indian Health. “I am worried about the people who are losing out on the care they need. … Dental infections can actually be life-threatening.”

There are more than 55,000 Medi-Cal-eligible people living in Butte County alone. Northern Valley Indian Health serves Butte and Tehama counties, and is one of only three federally qualified health centers (FQHCs) in Butte County, Sage said. Contrary to the clinic’s name, only 30 percent of the patients seen are Native American, he said.

Prior to Wednesday, about 40 percent of the clinic’s dental income came from adult Medi-Cal patients. The clinic puts the potential loss of business at about $2.25 million annually.

Sage is doubly disappointed in the state because the money needed to pay for these FQHC patients does not come from the state, but rather from the federal government. “They are not only leaving their medical patients with no place to go, but it wouldn’t cost them anything [to continue treating them],” Sage continued.

“You wouldn’t believe the things we see on a daily basis,” Sage said, describing patients with decaying teeth that have rotted off at the gum line, “dental cripples” without back teeth to chew food or abscessed roots buried in gum tissue. Now these patients will receive antibiotics and pain medicine in an emergency room and will revisit the hospital when the pain is no longer in control.

The cuts won’t save the state money, Sage insisted: “Each visit to the hospital will cost more than it would cost to treat the original problem.”

Abbaszadeh says he doesn’t think many Medi-Cal patients even know about the cuts. The state sent a one-page letter explaining the changes in the program, but Abbaszadeh says it may have been confusing or they may not have even read it. Many found out when they went to the dentist.

That’s how Cari Martinez, 51, first heard the news. Martinez has only a partial denture, and dentists predicted she would eventually need a full piece. But now she is afraid—her jaw is swollen with an abscessed tooth that may now be pulled and not replaced, due to the Medi-Cal cuts. Unable to afford dentures, she is worried she won’t be able to chew properly.

She is also worried about the effect on her general health. She is overweight and suffers from diabetes and degenerative arthritis in both knees.

“I don’t understand how [the state] can do this,” Martinez continued. “What does the governor think is going to happen to these people?”