More than half the state's low-income children are going without dental care because there aren't enough dentists willing to treat the young who are on government insurance, a new report released today says.
In 2011, 58.6% of the children enrolled in Medi-Cal did not receive any dental service, according to "In Search of Dental Care," a report by the Pew Charitable Trusts. Nationwide, the report found more than 14 million children enrolled in Medicaid did not receive any dental service.
"If you are unable to get yourself to a private dental office and pay for the care, you're going to be underserved," said Shelly Gehshan, director of the Pew Children's Dental Campaign.
Medi-Cal reported 47.4% of Fresno County children saw a dentist in 2011, meaning more than half of the children enrolled did not. Medi-Cal is California's version of Medicaid, a state-federal health program for the poor.
Fresno County health providers said problems accessing dental care only will increase in coming months.
The state is set to enroll about 1 million additional children statewide in the Medi-Cal dental program in 2014 — almost a 25% increase. Later this year, however, the state is poised to reduce how much it reimburses medical providers. The result will be fewer dentists willing to treat low-income children, the providers said.
"We didn't have enough Medi-Cal providers as it was," said Treva Lee, a Fresno dentist.
Valley counties are dental manpower shortage areas — regions that have a scarcity of dentists relative to the population. According to the Pew study, nationwide 45 million Americans live in dental shortage areas.
Compounding the dentist shortage: Dentists are aging and are not being replaced quickly enough. According to Pew, 37% of dentists nationwide are over 55; in California, the figure is 32.6%.
Children's dentistry also is a small speciality, requiring special skills for handling and treating young patients.
"Dentists are not interested in Medi-Cal and doubly not interested in low reimbursement for a child that wiggles in the chair," said Stephen Schilling, chief executive officer at Clinica Sierra Vista, which has community health centers in Bakersfield and Fresno.
"I don't even have here at any of our Clinica sites a full-time pediatric dentist."
Finding dentists — even those trained to treat adults — can be tough. Clinica has 30 health centers and it provides dentists for adults and children at six of its centers. The Elm and West Fresno centers in Fresno have dentists.
According to the Pew report, roughly 1-in-4 federally funded health centers in low-income communities did not offer dental services in 2011.
Without dentists willing to see low-income children and adults, costs of emergency room dental care increase. According to the Pew study, more than 830,000 Americans were treated in emergency departments in 2009 for abscesses and other dental emergencies.
And the hospital visits are costly. Pew said a national study found that treating decay-related cases in emergency departments cost nearly $110 million in 2006.
Fresno's Surabian Dental Center in the Community Regional Medical Center Ambulatory Care Center treated 1,070 adults and 208 children referred from Fresno-area emergency departments between July 2010 and May 2013.
"All through the country where they've lost Medicaid benefits for dental they're seeing a huge impact in the emergency rooms and more and more people are starting to document that, but the problem is not all the emergency room facilities have dentists available," said Stanley Surabian, dentist and chief of dental services at Community Medical Centers and program director of the dental residency program.
Communities are facing a dental dilemma, said Jenny Kattlove of The Children's Partnership, a nationwide nonprofit research and advocacy organization based in Santa Monica.
Low reimbursement rates are one of the main reasons that dentists don't accept Medi-Cal, Kattlove said. Yet, by the end of 2013, more than half of all children in California will be enrolled in Medi-Cal, she said. "We must make sure we have the providers and they must be paid at a market rate."
Officials at California's Department of Health Care Services, which oversees Medi-Cal, said the state is closely monitoring access to care for Medi-Cal members. "If problems occur, we will quickly address them," the agency said in an email.
Gehshan of Pew said low-reimbursement rates are not the only factor limiting access. It can take several attempts to submit a Medicaid claim to get little in return, she said. "The hassle factor is major."
To address the work force shortage, Pew said, expanding the types of providers allowed to perform services could be a solution.
About 15 states are considering legislation that includes training dental hygienists or other practitioners to perform more services. In California, the California Dental Association passed a resolution in 2011 encouraging a study of the safety and effectiveness of using mid-level providers, Pew said.
Schilling with Clinica Sierra Vista supports the concept. "We would love to have advanced-practice registered dental assistants," he said.
However, Lee, the Fresno dentist, has some trepidation. "I'd have to take a really hard look at it," she said. Many of the lower-income children in need of dental care are "more medically compromised, especially here in the Valley."
Percent of Medi-Cal children seeing dentists in 2011
Fresno County: 47.4%
Merced County: 44.9%
Mariposa County: 43.5%
Madera County: 49.4%
Kings County: 45.3%
Tulare County: 47.3%
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