Steinberg calls for immediate changes to Sacramento County dental program

The political back-and-forth over Sacramento County’s failing Denti-Cal program is heating up.

Senate President Pro-Tem Darrell Steinberg, D-Sacramento, on Monday called on the state’s Medi-Cal chief to take immediate action to improve dental care for more than 110,000 Sacramento County children.

In a letter to Toby Douglas, director of the Department of Health Care Services, Steinberg said Sacramento County kids can’t wait for the department to draw up new contracts with dental plans before they get better care.

“Immediate steps need to be taken now to improve access to dental care for children,” Steinberg wrote. “It is clear the existing managed care system is inadequate.”

This is the third letter that the two have exchanged over Sacramento County’s Medi-Cal dental program in recent weeks. The county’s “geographic managed care” model is unique in California, but has a poor record.

In fiscal year 2010-2011, 30.6 percent of Sacramento County 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, described the program’s shortcomings, and gave examples of children who have waited months to receive treatment for painful, rotted or broken teeth.

Under the Sacramento County model, the state pays private dental plans a monthly fee – currently 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 dental programs in the state are “fee-for-service,” with dentists being paid for each visit they report.

In his letter to Steinberg last week, Douglas said his department is committed to improving dental care for Sacramento kids and promised quicker resolution to complaints from patients. He also said the department will get tougher on dental plans that fail children, either by withholding payments or by terminating their contracts.

Douglas said it would be “most expedient and effective” to keep Sacramento kids in the managed care program rather than shifting them into fee-for-service, in part because the state would have to alter agreements with the federal government, which provides some Medi-Cal funding.

So, to improve the existing program, his department is reviewing existing contracts and preparing to beef up new contracts, which take effect between July 1 and Jan. 1, he said.

In his latest letter, Steinberg countered that Sacramento kids can’t wait. He urged Douglas to change the program immediately, giving Sacramento County families the choice between managed care or fee-for-service.

“Some contracts do not expire until January 1, 2013. I find it unacceptable to wait that long without appropriate services and monitoring being in place,” he wrote.

Don McClurg, chair of Sacramento County’s Public Health Advisory Board Denti-Cal Subcommittee, applauded Steinberg’s push for quick action.

“It is a dental emergency and has been for a while, and it would be a shame to let the (department) say, ‘Well, don’t worry, even though we haven’t managed this for 18 years, we have a new contract and we’ll take care of it,’” he said. “I don’t think we can trust that.”

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