The California Dental Association (CDA) is urging immediate steps, including a reversal of a 10% provider reimbursement cut, to address critical issues with the state's Denti-Cal Medicaid dental program, which is failing to provide adequate access to care for millions of low-income children who are at risk of developing dental disease.
An audit issued by the Bureau of State Audits validates what CDA has experienced with the program for many years, according to the association.
The audit, whose findings are published in the report "California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care," found that nearly 56% of the 5.1 million children enrolled in Denti-Cal in 2013 did not receive any dental care in 2013. Additionally, the audit identified that there is a lack of providers in a number of California counties, including five counties with at least 2,000 children in the program that may not have had any active dental providers.
"For years, CDA has advocated for action to correct the critical lack of access to care for children enrolled in the Denti-Cal program, and this audit shows just how serious the crisis is," said CDA President Walt Weber, DDS. "Dental disease is the number one chronic childhood disease and one of the top reasons children are absent from school. We need to ensure they can access the care they need to be healthy."
The auditor's report attributed Denti-Cal's low reimbursement rates, ranked among the lowest in the U.S., as one of the primary reasons for the lack of providers participating in the program. It noted that California's reimbursement rates, which have not increased since 2000, are 35% below the national average, with the 10 most common procedures authorized for payment averaging $21.60. Additionally, the state's 10% Medi-Cal rate reduction implemented in 2013 applied to pediatric dental providers, while nondental pediatric providers were exempt from the cuts.
The report, which also criticizes the Department of Health Care Services for inadequate oversight of Denti-Cal, expresses serious doubts about Denti-Cal's ability to accommodate millions of new children and adults who gained coverage through eligibility expansion.
"The state has a responsibility to ensure there is an adequate network of dentists to provide needed care, but the low reimbursement rates mean dentists have to provide care at a loss, and unfortunately, many who would like to participate in Denti-Cal are unable to do so," Dr. Weber said. "CDA is urging the state to take immediate action to reverse the 10 percent reimbursement cut and increase rates to acceptable levels to ensure we have a sufficient network of providers throughout the state. We hope to continue to explore and address these issues through a robust legislative process."
