There are many stories across California of children currently enrolled in Medi-Cal waiting months to see a dentist. Sadly, unless some steps are taken, this issue will only worsen as major changes affecting the state's dental care system take effect this year.
One big change is the recent elimination of California's Healthy Families Program, resulting in nearly 900,000 children being transitioned over to Medi-Cal. This means that by 2014, roughly half -- 5 million -- of California's kids will receive their dental coverage through Medi-Cal. In addition, we expect to see hundreds of thousands of additional children enroll in Medi-Cal as the result of the Affordable Care Act beginning to be implemented across the country in less than 12 months.
Unfortunately, Medi-Cal's dental program is currently failing too many children. While the state is taking steps to address the program's shortcomings, the problems are substantial. For starters, half of the children enrolled in Medi-Cal did not have a dental visit in 2011. This issue boils down to a fundamental problem of access to dental care. Indeed, only 35 percent of dentists treated children on Medi-Cal, according to the most recent data available. And an even smaller percentage of this group saw the vast majority of those children.
Parents of children in pain and in need of simple dental treatments, like fillings, find their kids on months-long waiting lists for the few dentists that accept new pediatric Medi-Cal patients. Without prompt attention, cavities can turn into abscesses, and toothaches can turn into extractions or infections. These time delays and shortages of providers result in parents sometimes having to drive their children hundreds of miles for care that those of us with adequate dental care options often take for granted. Unless action is taken, this situation will become even more dire as additional children enroll in Medi-Cal.
What can we do? The Children's Partnership (TCP) has published an issue brief, "Fix Medi-Cal Dental Coverage: Half of All California Kids Depend Upon It," which lays out a plan to strengthen Medi-Cal's dental program for children. First, we need to ensure that there are enough providers enrolled in Medi-Cal to adequately meet the dental care needs of currently- and newly-enrolled children. Specifically, TCP is calling on state leaders to make sure providers will participate in Medi-Cal by encouraging the state to raise the reimbursement rates for dentists serving children on Medi-Cal and streamlining bureaucratic processes that keep providers away from Medi-Cal. Currently, California ranks 42nd in the nation for reimbursement rates, leaving little wonder as to why Medi-Cal's programs have a difficult time recruiting enough dentists.
Next, we need to ensure that enrollment in dental coverage is simple for families and that those enrolled understand their benefits. Parents need to understand that their children are entitled to dental benefits (and how to access care), even if the parents themselves are not entitled to dental insurance.
Third, we must think outside the box and look at creative ways to deliver dental care to children who need it most. For example, telehealth -- the use of technology to deliver health care -- is an effective way to provide some dental care and screenings to children where they are located, such as at school. We should also explore expanding the dental team with additional providers who are trained to provide routine dental care to children. Much like nurse practitioners, such providers can provide high-quality care to children in a cost-effective way.
Finally, California needs real leadership in oral health. California has not had a dental director in years. Without a strong office of oral health, led by a dental director, California is missing opportunities to ensure children have the best dental care possible.
The challenges laid out above provide the opportunity for California to strengthen the system for everyone. It will require a lot of cooperation and political will to make these changes. TCP calls on the governor, legislators, and the public to ensure that California's most vulnerable kids will not be lost in the shuffle and left without the dental care they need.
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