Demands escalate to change kids' dental plan in Sacramento

This story originally appeared in The Sacramento Bee.

Political opposition to Sacramento County’s managed care dental program for poor children is mounting, and Thursday was a particularly busy day in the campaign for change.

State government officials promised new accountability after elected representatives, county supervisors and advocates demanded better care for the more than 110,000 Sacramento County children who receive dental coverage through Medi-Cal, the state’s insurance program for low-income residents.

The county operates the state’s only mandatory managed care model, and government data show it has one of the state’s worst records of care. In fiscal year 2010-2011, less than one-third of Sacramento children with Medi-Cal saw a dentist, compared with nearly half of children on Medi-Cal statewide.

A CHCF Center for Health Reporting story, published Feb. 12 in The Sacramento Bee, gave examples of children who have waited months or years to receive treatment for painful, rotted or broken teeth.

On Thursday, the political tug of war intensified.

-- The director of the Department of Managed Health Care told members of a Senate budget subcommittee that his department is embarking on an immediate review of the five dental plans that participate in Sacramento’s managed care program.

The audit will address access to care, quality of care and other issues, Director Brent Barnhart said. “We will use our regulatory authority to ensure all health plans, including those that serve Medi-Cal recipients, follow the law,” he said.

The Department of Health Care Services (DHCS), which administers Medi-Cal, also has enforcement authority over the plans because it contracts with them directly to provide services.

-- In the latest letter between DHCS Director Toby Douglas and Senate President Pro Tem Darrell Steinberg, D-Sacramento, Douglas wrote that he is working with the Department of Managed Health Care to coordinate oversight.

In the letter, dated March 7, he also compiled a list of actions he expects dental plans to take to improve children’s access to care, such as sending letters to beneficiaries explaining benefits and calling beneficiaries to set up dental appointments.

-- At a press conference at an Oak Park clinic, Assemblyman Richard Pan, D-Sacramento, and other local leaders called on DHCS to give Sacramento families on Medi-Cal the temporary option to leave managed care.

Currently, the state pays the dental plans a monthly fee – about $12 – for each Medi-Cal child assigned to them. The fee does not depend on whether the child actually sees a dentist. Critics of the program say the model discourages dentists from seeing patients because they get paid either way.

In contrast, most other county Medi-Cal children’s dental programs in the state are “fee-for-service,” with dentists being paid for each visit they report.

Pan said Sacramento children should have the fee-for-service option, too. “Our children must have direct access to dental professionals until proper reforms and oversight can be implemented,” he said.

Next Thursday, March 15, Pan will chair a special hearing at the Capitol that will focus on Sacramento’s Denti-Cal program.

Also next week, the Sacramento County Board of Supervisors will discuss the dental program on Tuesday, March 13, and hear recommendations from the county’s Public Health Advisory Board on how to improve access and care.

Even though the state contracts directly with dental plans to provide coverage to Sacramento residents, “we have a role in advocating for the health of families and children,” said Board Chair Don Nottoli. “Something needs to change.”

Supervisor Phil Serna, who chairs First 5 Sacramento, said change should come quickly. “I’m not interested in having this conversation with you a year from now about what’s happened since last year,” he said. “I want to make sure eligible children are being seen by dentists.”

Some advocates are losing patience with promises for change, including Cathy Levering, executive director of the Sacramento District Dental Society. The Sacramento managed care dental program started almost two decades ago, in 1994.

“This is all great, and they’re answering now because the pressure is on them. But why has this gone on for 18 years?” she asked. “They could have made improvements in the last 18 years and they haven’t.”

She and others also point out that this isn’t just about Sacramento. The state is embarking on a statewide expansion of managed medical care under Medi-Cal.

Sen. Mark DeSaulnier, D-Concord, who chairs the budget subcommittee, alluded to the expansion in Thursday’s Capitol hearing and urged caution.

“I’m convinced that managed care came from a public relations firm rather than someone actually involved in health care. It sounds wonderful, but as you know, the devil is in the details,” he said. “The Sacramento case was very demonstrative in things not going right.”

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