LA-area legislators criticize county’s dental program for poor children

This story originally appeared in The Los Angeles Daily News and other MediaNews newspapers.

SACRAMENTO – Southern California legislators are vowing to press for changes in Los Angeles County’s dental program for poor children, saying it’s unacceptable that fewer than one in four kids on managed care saw a dentist last year.

“Obviously, I’m concerned,” said state Sen. Ed Hernandez, D-West Covina, who chairs the senate health committee. “The most needy population needs to absolutely have access to healthcare.”

Of the roughly 900,000 children with Medi-Cal in Los Angeles County, about 154,000 receive their dental care from a managed care plan. State data show that they are among the least successful in California at obtaining dental care.

In fiscal year 2010-2011, 23 percent of them saw a dentist, compared with about 31 percent in Sacramento – the only other county with Medi-Cal dental managed care – and about half of all Medi-Cal kids statewide.

A story by the CHCF Center for Health Reporting that appeared in The Daily News over the weekend gave examples of children on the managed care plan who lived in pain while waiting months to get their teeth fixed.

Hernandez said the state needs to take a serious look at what it pays to plans and dentists to participate in the program.

Unlike Sacramento County, where dental managed care is mandatory, Los Angeles County’s Medi-Cal program allows parents to sign their kids up for a dental managed care plan, or opt for the “fee-for-service” approach used in the rest of the state.

Under managed care, the state contracts directly with private dental plans, paying them a monthly fee – currently about $11.50 – for each child, whether or not the child actually sees a dentist. 

The plans pay clinics and dentists a lesser amount per month, often between $4 to $6, to provide the care. Fee-for-service, on the other hand, allows dentists to bill Medi-Cal for services, which results in a substantially higher reimbursement.

“We need to look at addressing provider reimbursement rates to encourage providers to be able to take more of these patients,” Hernandez said.

Assemblywoman Holly Mitchell, D-Los Angeles, sits on the Assembly Health Committee and said she is considering holding a Capitol hearing on the issue.

She believes some of the access problems may stem from previous decisions state lawmakers made, including the elimination of Medi-Cal coverage for most adult dental services in 2009, which she called “offensive.”

That decision “has ultimately had a huge impact on the availability of dentists. Period. Especially those willing to engage in a contract with the state,” she said.

She and other legislators acknowledged that the state is facing another massive budget deficit, estimated by Gov. Jerry Brown at about $16 billion, but that certain services, such as children’s dental care, must be protected and improved.

Efforts are under way to address the performance of Sacramento and Los Angeles Counties’ Medi-Cal dental managed care programs.

In recent months, the state Department of Health Care Services (DHCS), which administers Medi-Cal, has promised quicker resolution to complaints from patients, better enforcement and pledged that the department will get tougher on plans that fail children, either by withholding payments or terminating their contracts.

In response to a state audit, one of the managed care dental plans, Community Dental Services, said it will cease operations June 1 and transfer its enrollees to another plan.

The department also is beefing up new contracts that will take effect in January in Sacramento and July 2013 in Los Angeles County.

“We are pleased that the steps we are taking to improve access and quality issues in our managed care dental plans are paying off,” said DHCS spokesman Norman Williams. “We will continue to work with the plans and our stakeholders to improve performance, strengthen oversight, and ensure that our beneficiaries receive high quality care in a timely manner.”

Senate President Pro Tem Darrell Steinberg, D-Sacramento, has introduced legislation that would give Sacramento County children the option to switch to fee-for-service under certain circumstances.

The legislation also would establish stricter standards for dental plans and tougher enforcement by state agencies, which would apply to Medi-Cal dental managed care contracts in LA County as well.

“When I see 23 percent, it’s not acceptable,” Steinberg said of the LA County managed care access rate. “Between the executive branch and DHCS and the Legislature, we are going to continue to ride herd on this issue until those numbers go way up.”

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