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Friday, May. 29, 2009

Medi-Cal dental benefits expiring soon

Emergency rooms not prepared to handle expected patient influx

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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.