Who’s on first? In children’s dental care, few know

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.

A CHCF Center for Health Reporting story, published Feb. 12 in The Sacramento Bee, described problems with this model, and gave examples of children who have waited months to receive treatment for painful, rotted or broken teeth.

In most other counties, Medi-Cal offers dental care on a fee-for-service basis, which reimburses dentists for each visit they report.

Because San Diego is also a geographic managed care county, several experts and lawmakers at the hearings assumed that San Diego also provided dental care through managed care.

Not so.

Health care consultant Barbara Aved set the record straight Thursday near the end of a Capitol hearing chaired by Assemblyman Richard Pan, D-Sacramento. Her firm wrote the 2010 report commissioned by First 5 Sacramento that took a critical look at the Sacramento program.

— Sacramento County is indeed the only county where managed care is mandatory for Medi-Cal dental services, she said.

— San Diego, though it is a geographic managed care county for health care, offers its dental benefits on a fee-for-service basis.

— And Los Angeles County offers dental managed care on a voluntary basis, so Medi-Cal recipients can choose between that or fee-for-service.

Managed care for dental “only exists in Sacramento and L.A. It actually didn’t exist in San Diego,” she said. “They considered it and rejected it.”

Why does this matter? Facing relentless budget cuts, the state is hoping to save money by expanding Medi-Cal managed care for medical benefits. Expanded managed care for dental is also under consideration.

But Sacramento’s track record on managed care has been dismal: 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.

“This particular system after two decades just doesn’t have the kind of quality control measures and provide the access,” Terrence Jones said at Thursday’s hearing. Jones is a dentist and a past president of the Sacramento District Dental Society.

Cindy Weideman, a pediatric dentist in Sacramento, said she had to drop out of Sacramento’s managed care program after eight years of financial losses because of low reimbursement rates, bureaucratic red-tape and other issues.

Since then, she has continued to see some low-income children for free.

“We were idealistic and we said, ‘We’re going to take Medi-Cal because we want to help these children’,” she said. But “it was cheaper for us to see the children for free than it was to take Denti-Cal.”

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