Editorial: Dental plan for poor kids is a mess
Imagine having a toddler with a painful toothache. You take him to the dentist you've been referred to by Medi-Cal, but your child is not seen. Months later when he is treated, all of his baby teeth are decayed and infected.
Sadly, this story and similar ones are not uncommon for poor children in Sacramento County. In 1994, Sacramento was chosen to test a new dental health care model, "geographic managed care." Under it, dental plans that contract with the state receive a set amount of money, $12 per child assigned to them per month. Managed care is supposed to be cheaper than traditional fee-for-service and more comprehensive because it covers preventive as well as emergency services.
Apparently no one from the state bothered to monitor the program to make sure children were getting the services for which the state paid. As reporter Jocelyn Wiener with the Center for Health Reporting documented in The Bee on Sunday, poor Sacramento children were routinely denied dental care to which they were entitled. Last year, Sacramento ranked third worst in the state in the number of dentist visits per child enrolled in Medi-Cal. Sacramento was dead last in percentage of poor kids seen by dentists in the previous three years.
Representatives for some of the large dental plans that contract with the state blame Medi-Cal paperwork and slow and low reimbursement rates. But interviews with parents and records reveal both bureaucratic indifference and financial disincentives to provide care.
Dental plans get paid even if services are not provided, and there are no sanctions for those who refuse to treat eligible patients.
The state's managed care pilot dental project never went beyond Sacramento County. No wonder. Sacramento's First 5 Commission published a critical report in 2010 that showed children were not getting care, but little changed.
Senate President Pro Tem Darrell Steinberg has asked the California Department of Health Care Services to investigate. But since the problem appears to rest with that department, it makes more sense to have the state auditor look into it.
But enough investigations – the state needs to require dental plans they contract with to provide promised services. If they don't, then stop paying them and send the money to others who will.