Cavity kids: Poor Sacramento children have low access to dental care

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Summary: 

Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs and improve children’s ability to see a dentist. Today that model persists – but state data shows that the county has consistently produced one of California’s worst records for care. In 2010, only 30 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care - above only rural Alpine and Trinity counties. During the three previous years, it was the state's lowest performing children's dental system, state numbers show.

Impact Summary: 

Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs and improve children’s ability to see a dentist. Today that model persists – but state data shows that the county has consistently produced one of California’s worst records for care. In 2010, only 30 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office.

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Jocelyn Wiener, CHCF Center for Health Reporting | February 13, 2012
This article originally appeared in The Sacramento Bee. Cheri Flores brushes son Julian's aching teeth in early December. The boy developed decay as a toddler from falling asleep while drinking a bottle. She says he wasn't seen at 1 1/2 on his first dental visit or at two subsequent appointments. (Lezlie Sterling/The Sacramento Bee)
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Sacramento Bee | February 13, 2012
Senate president pro tem Darrell Steinberg is calling for a state review of a Sacramento County pilot program that provides state-funded dental coverage for low-income children. A Center for Health Reporting article published in The Bee over the weekend detailed the shortcomings of the managed care program, including long wait times and comparatively low rates of dental care among the more than 110,000 Sacramento County children covered by the program.
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Jocelyn Wiener, CHCF Center for Health Reporting | February 13, 2012
State Senate President pro tempore Darrell Steinberg is calling on the state Department of Health Care Services to investigate allegations into “lax accountability and inadequate patient access” for poor Sacramento children with Medi-Cal who are insured by dental managed care plans. The letter comes in response to a story by the CHCF Center for Health Reporting, which ran in The Sacramento Bee on Sunday, February 12, 2012. The story documented longstanding problems with the “geographic managed care” dental system, which the state imposed on Sacramento County as a pilot program 18 years ago.
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The Sacramento Bee | February 14, 2012
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.
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Joyce Terhaar, Sacramento Bee Executive editor | February 21, 2012
This story was originally published on February 19 in the Sacramento Bee.
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Richard Kipling, CHCF Center for Health Reporting | February 23, 2012
Sometimes good things get cut out of good stories. This happened on my editing watch recently, when a story by Jocelyn Wiener on poor kids’ dental health access in Sacramento grew too big and had to be pared back. This is where blogs come in handy. I can reach in, restore and expand on a relevant piece of information that otherwise would be lost to the cutting room floor or, more accurately, the delete key.
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Emily Bazar, CHCF Center for Health Reporting | February 24, 2012
This story originally appeared in The Sacramento Bee. The state's Medi-Cal chief, under pressure to improve dental care for Sacramento's poor children, pledged this week to implement changes so kids won't have to wait months to receive treatment for painful, rotted or broken teeth.
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Emily Bazar, CHCF Center for Health Reporting | February 28, 2012
This story originally appeared in The Sacramento Bee. 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.
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The Sacramento Bee  | March 1, 2012
Perhaps the bureaucrats who run the state's Medi-Cal dental program would move more quickly to improve dental service for Sacramento kids if it were their own children waiting for months for their cavities, broken teeth and abscessed molars to be treated. Senate President Pro Tem Darrell Steinberg is insisting justifiably that Medi-Cal officials act without delay to get taxpayer-funded dental services to kids who need them and are entitled to them. Under a pilot managed care program established 18 years ago, Medi-Cal pays dentists $12 per month per patient to treat poor children. Dentists get paid whether they treat the children or not. Studies have shown that dentists routinely turn away eligible kids, even those with the most serious and painful dental conditions.
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Emily Bazar
CHCF Center for Health Reporting | March 8, 2012
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.
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Emily Bazar
CHCF Center for Health Reporting | March 13, 2012
This story originally appeared in The Sacramento Bee. Seeking to break managed care’s monopoly on dental care for Sacramento County’s poor children, state Senate leader Darrell Steinberg plans to introduce legislation to allow more choice in who kids can see, his aide told the Sacramento County Board of Supervisors Tuesday. More than 110,000 Sacramento County children on Medi-Cal participate in a mandatory managed care model for dental care, the only one of its kind in the state.
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Emily Bazar, CHCF Center for Health Reporting  | March 16, 2012
Even the experts are confused. At two public hearings this week to discuss problems with Sacramento County’s dental care program for poor kids, not all the expert witnesses agreed on which California counties provide Medi-Cal dental services via managed care. Let’s start with what they did agree on: Sacramento. Sacramento has been exclusively a “geographic managed care” county for nearly two decades, debuting as a pilot project in 1994. Under geographic managed care, the state contracts directly with private dental plans, paying them a monthly fee – about $12 – for each Sacramento County Medi-Cal child assigned to them.
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Emily Bazar
CHCF Center for Health Reporting | March 23, 2012
This story originally appeared in The Sacramento Bee. The Legislature took its first formal step Thursday to free Sacramento County's poor children from the confines of mandatory managed dental care. A Senate committee unanimously approved a proposal by Senate President Pro Tem Darrell Steinberg, D-Sacramento, to give Sacramento County children on Medi-Cal a choice for their dental coverage. The legislation also would establish stricter standards for dental plans and tougher enforcement by state agencies.
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Kelley Weiss
CHCF Center for Health Reporting | April 6, 2012
This story originally aired on KQED Public Radio.
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Emily Bazar, CHCF Center for Health Reporting | April 16, 2012
Reaction to the center's story about problems with geographic dental 0managed care in Sacramento County was swift and far-reaching. The day after the initial article ran in The Sacramento Bee, state Senate President Pro Tem Darrell Steinberg penned a letter to DHCS director Toby Douglas demanding an investigation into the failures of the program and calling for corrective steps. In his initial response -- and in subsequent letters -- Douglas promised immediate action, including beefed-up enforcement, a quicker complaint process and a mailing to all Sacramento Medi-Cal recipients with information on how to access care and resolve concerns. He also vowed to toughen new contracts with dental plans that take effect Jan. 1, 2013.
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Emily Bazar, CHCF Center for Health Reporting | April 19, 2012
In our ongoing coverage of Sacramento County’s dental plan for poor kids, we’ve reported on proposals to fix its performance, including a measure in the Legislature that would fundamentally change the way the Medi-Cal program works there. But there’s another, earlier bill that advocates say would have statewide impact, especially for Californians who live in places where dental treatment is difficult to access.
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Emily Bazar
CHCF Center for Health Reporting | April 24, 2012