Susan Inglett’s dental coverage changed just after she got a root canal on one of her top teeth.
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It was 2009, and California was in the midst of a budget crisis. To cut costs, Medi-Cal, the state health insurance program for low-income residents, eliminated non-emergency dental benefits for adults.
Inglett, 63, of San Diego, needed a crown for that vulnerable tooth, but the state no longer paid for them.
She couldn’t afford one on her own, so she went without it. Since then, she has had three other teeth pulled because the dental services that would have saved them were no longer covered.
“You end up making choices about what you can and cannot afford,” Inglett says. “If a procedure comes up and you simply can’t afford it, and it’s cheaper to yank the tooth, then you take out the tooth.”
Soon, Inglett won’t have to choose between fixing her teeth and getting them pulled.
Starting in January, many of the dental services that were cut eight years ago will be restored for her and about 7.5 million adults on Medi-Cal, many of whom have had to get their teeth pulled instead of repaired.
Some benefits were partially restored in 2014, such as fillings and X-rays, but critical treatments remain uncovered, including lab-processed crowns, root canals on back teeth, treatments for gum disease and partial dentures.
Those procedures will be covered once again in 2018. But a critical question looms: Will there be enough dentists willing to accept the rates that Denti-Cal – Medi-Cal’s dental program – pays for them?
“The vast majority of dentists don’t accept Denti-Cal patients because they can’t afford it,” says Sigmund Abelson, associate dean for clinical affairs at University of the Pacific’s dental school.
The school operates clinics in San Francisco and Union City that treat about 2,500 Denti-Cal patients a year, he says. Services are provided by students under the supervision of faculty.
Change helps overall health
Abelson says he believes the overall health of Medi-Cal enrollees will improve once full dental benefits are restored, assuming they can find participating dentists.
Oral and physical health are directly linked, and many Denti-Cal recipients have suffered from preventable illnesses because they couldn’t get appropriate dental care, Abelson says.
Some ended up in emergency rooms, “many times with acute infections that could have been treated by dentists,” he says.
Patients like Inglett who are missing teeth tend to start eating more processed foods and soft foods, says her dentist, Misako Hirota.
“That in itself creates a lot of other problems,” such as diabetes, obesity and high blood pressure, she says. “It’s all a vicious cycle.”
Among the treatments that will be restored by Denti-Cal in January, Abelson ranks root canals and special cleanings for people with gum disease as two of the most important.
Under the current rules, root canals on back teeth are not covered. Extractions, on the other hand, are.
Starting in January, all teeth will be eligible for root canal coverage, Abelson says.
For patients with gum disease, Denti-Cal also will cover “scaling and root planing,” which is a deep cleaning below the gum line that can help reduce infections in the mouth, Abelson says.
“Remember, your gums are holding in your teeth,” he says. “There’s no point in fixing a tooth if you have bad gums. You may ultimately lose the tooth.”
Hirota is thrilled that her patients will be eligible for partial dentures starting next year. Since benefits were partly restored in 2014, enrollees have been able to get only full dentures. That means any remaining teeth have to be pulled before patients can qualify, Hirota says.
Having dentures “makes all the difference in the world for your confidence, and for your ability to get a job and present yourself in public,” she says.
Inglett is grateful for the upcoming changes. If the benefits were not going to be restored, she would have to get more teeth pulled. “I am at the point where I would have to keep sacrificing my teeth,” she says.
Finding a dentist who takes Medi-Cal
Inglett already has a dentist who accepts Medi-Cal. Enrollees who don’t might have difficulty finding one.
A scathing report on Denti-Cal last year by the Little Hoover Commission, an independent state oversight agency, noted that just a quarter of California dentists participate “due to its low reimbursement rates and administrative obstructions.” Finding a Denti-Cal dentist in rural counties can be next to impossible.
But state officials say they are engaged in a statewide outreach effort to recruit more dentists and have simplified the enrollment paperwork for providers.
And earlier this year, Denti-Cal increased the rates it pays dentists for hundreds of procedures by 40 percent, a boost that was funded by the tobacco tax, Proposition 56, which voters approved in November 2016.
Hirota’s regular charge for a filling that repairs damage on two surfaces of a tooth is $130. Before the rate hike, Denti-Cal paid her $48, but that grew this year to $67.20, she says.
Hirota believes more dentists may start to accept Denti-Cal patients now, but Abelson is skeptical that the rate hikes will be enough to entice an adequate number of dentists.
To search for dentists who accept fee-for-service Denti-Cal, which is the primary service model for most of the state, visit the Denti-Cal website at bit.ly/DCDentists or call 800-322-6384.
You can also call your local dental society, which likely maintains a list of dentists in the area who accept Denti-Cal. You can find your branch by visiting the California Dental Association website (www.cda.org) and clicking on the “About CDA” tab.
Like University of the Pacific, many dental schools accept Denti-Cal patients, Abelson says. However, they are concentrated in the Bay Area and Southern California, so they won’t be accessible to all Californians.
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation. Questions for Emily: AskEmily@kff.org