Medi-Cal dental benefits expiring soon

Emergency rooms not prepared to handle expected patient influx

May 29, 2009 

  • AT A GLANCE

    THE ISSUE: Medi-Cal patients are set to lose dental benefits July 1 under the Denti-Cal program.

    WHAT IT MEANS: Hospital emergency departments and low-cost clinics expect to see a surge of patients with untreated dental conditions.

    WHAT'S NEXT: Health care advocates and industry groups are urging state leaders to extend the benefits or continue coverage for certain procedures.


As of July 1, the state Medi-Cal system no longer will cover dental care for low-income adults.

The cuts are expected to save the state $115 million a year, but the fallout could be ugly for the adults, seniors and disabled people who rely on the program for dental care.

Hospital emergency rooms in Stanislaus County already are seeing patients with untreated dental conditions. And the cuts will hurt clinics that serve large numbers of Medi-Cal patients, such as the Western Dental Centers and Golden Valley Health Centers.

Besides the elimination of Denti-Cal benefits, the state Department of Health Care Services no longer will pay for podiatry, optometry, audiology and psychology serv-ices for adults on Medi-Cal. Coverage will continue for children, pregnant women and residents of skilled nursing facilities.

Developmentally disabled adults in the Northern San Joaquin Valley should have access to dental care through the Valley Mountain Regional Center, although the center is having trouble contracting with dentists who will treat clients at rates similar to the Denti-Cal rates, its director said.

State leaders decided to eliminate the so-called optional Medi-Cal benefits as they deal with huge budget deficits. With the failure of recent ballot measures that would have preserved the benefits, patients such as Karlyn Echols of Modesto are in a hurry to get treatment for tooth decay.

"I need a lot of dental work," said Echols, a 69-year-old resident of Ralston Towers in Modesto. "They are telling me I have to hurry up because after July 1 they won't be able to help me."

Dental offices that accept Medi-Cal are turning patients away if they can't get authorization for care before July 1 and the patient doesn't want to pay cash.

In Stanislaus County, there are 54,324 adults eligible for Denti-Cal, including 11,441 people age 65 or older. The California Healthcare Foundation has reported that 25 percent of the beneficiaries use the dental program in a typical year, with an average expenditure of $380 per patient.

Many likely to delay care

With the tough economy, many of those who lose coverage likely will delay care rather than pay for treatment, said Bruce Valentine, spokesman for the Stanislaus Dental Society.

As their tooth decay and pain gets worse, patients will bounce between emergency rooms that are not equipped for dental care and dental offices that expect patients to pay. In the meantime, they could develop severe oral infections.

"Without the benefit, the average patient who is low-income is not going to go to the dentist," Valentine said. "It will take a lot of patients out of the dental office and put them in emergency rooms."

Hospitals in Stanislaus County have oral surgeons on call for trauma cases, but usually do not provide "drill and fill" dental procedures.

Patients going to the ER could be charged for computerized tomography scans that cost 10 to 20 times more than the X-rays in dental offices, said Dr. Michael Cadra, an oral and maxillofacial surgeon in Modesto.

"Once this benefit is cut off, there will be a lot of adults who don't get appropriate dental care," Cadra said.

Patients losing benefits are not going to find a dentistry chair at Doctors Medical Center of Modesto.

"Other than trauma-related injuries to the oral or facial area, our emergency department does not treat dental problems and there are no plans to change that," said Carin Sarkis, a DMC spokeswoman.

Steve Mitchell, chief operating officer for Memorial Medical Center, said the hospital is billing Medi-Cal for a patient with a dental condition who recently came to the ER four days in a row. The patient ultimately was referred to an oral surgeon for a tooth extraction.

"The hospital isn't well- prepared to deal with dental issues," he said, noting it doesn't have dental X-ray equipment or anyone on call to perform general dentistry.

"We will perform a medical screening to determine the seriousness of the illness and also deal with the pain and prescribe antibiotics," he said. "But we will then need to recommend they follow up with a dentist. We'll also advise them to come back if their condition gets worse."

The Golden Valley Health Centers expect to lose significant reimbursements for dental services at eight of its health clinics in Stanislaus and Merced counties. The nonprofit health system will try to make up the losses by serving more children with Denti-Cal benefits, said Christine Noguera, deputy executive officer for Golden Valley.

Sliding fee may be option

The health centers, which provide medical services and basic dental care, could see a surge of low-income adults because its sliding fee scale may be an option for the thousands that lose Denti-Cal benefits. Depending on their income, patients are responsible for 25 percent to 75 percent of dental bills.

"We won't be able to meet all the demand that is out there," Noguera said. "Oral health is 100 percent connected to our physical health. It is putting these adults and their overall health at risk."

The benefit change also affects seniors and disabled people who have dual coverage from Medicare and Medi-Cal. Some are looking into purchasing supplemental dental, vision and hearing insurance, but most of the available policies are discount plans that don't offer much, said Cecilia Flores, a counselor for the Health Insurance Counseling and Advocacy Program in Modesto.

HICAP is advising seniors to ask their dentists about their prices and payment options, because it may be cheaper. "Some offices have credit card offers with a small percentage of interest or no interest charges if they are not late with their monthly payments," Flores said.

Cadra noted that dental disease is preventable with good oral hygiene and regular cleanings. He advised people who lose Denti-Cal benefits to set aside money for routine care and ask their dentists about payment plans.

The California Dental Association continues to urge Gov. Schwarzenegger to extend the benefits or have Medi-Cal cover procedures that would save a tooth for a patient. In 2004, Michigan eliminated its Medicaid dental benefits and then restored them two years later because of cost pressures on its health system.

"When they brought the program back, about one-third fewer dentists participated," said Dean Chalios, vice president of public policy for the Dental Association. "A program like adult dental care is not something you can turn off and turn on again."

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.

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