California state Senate president demands investigation into Sacramento child dental providers

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.

Citing local officials and dentists, individual families and state data, the article said that Sacramento County has consistently had one of the state’s worst records of providing dental care for poor children. The letter also cites a 2010 report by First 5 Sacramento that criticized the program.

“Disturbing specific patient cases as well as the department’s own data cited in the article make it abundantly clear that prevention and treatment services are woefully inadequate for those children most in need,” Steinberg states in the letter to the department’s director, Toby Douglas. Steinberg voiced particular concern about the state’s lack of contract enforcement with the dental plans, calling for “urgent actions,” including the withholding of payment and contract termination for poor performance.

“We’re not talking about a cavity that’s creating just a little bit of discomfort,” Mark Hedlund, Steinberg’s press secretary, said Monday in an interview. “We’re talking about people with a broken tooth or abscesses or toothaches. It’s just awful to think of kids having to go through that. They should be getting the care that they need.”

Hedlund said that, while Steinberg had not outlined a specific timeline for a response, he is “hoping to get some kind of response relatively quickly and go from there.”

Cathy Levering, executive director of the Sacramento District Dental Society, a professional group that represents 1,545 dentists in the Sacramento region and who has been a persistent critic of the managed care program, called Steinberg’s call for an investigation “awesome.”

“I think it’s about time,” she said. “We’ve been witnessing this for 20 years.”

Debra Payne, a health and dental program planner for First 5 Sacramento who has led the county’s effort to reform children’s dental services, said the letter from Steinberg’s office is especially important as the state considers moving more poor children with government insurance into managed care, “putting more pressure on an already broken system.”

“We may have an even bigger problem statewide,” she said, “not just in Sacramento County.”

In his letter, Steinberg says the performance issues outlined in the article raise the question whether the state is “prepared and equipped to proceed with any Medi-Cal managed care program expansions this year as proposed in the Governor’s January budget.”

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