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HOME > ABOUT > PRESS > MORE BUDGET CUTS AHEAD
Article published - March 11, 2009
Credit: PRESS DEMOCRAT
More Budget Cuts Ahead
By Martin Espinoza
Steven Lewis sat in a dentist’s chair in Petaluma on Wednesday afternoon as Dr. Ramona English examined, poked, scraped and tapped at his teeth.
The 50-year-old Petaluma resident has a broken lower first molar that needs a root canal, a post and core and a crown. State funding for adult dental care currently is on the latest chopping block and Lewis, a construction worker on disability, said he has no time to waste.
“I figured that at some point I wasn’t going to be able to get it done,” Lewis said. “They may one day end up just giving you a tooth brush.”
On Tuesday, the state Legislative Analyst’s Office reported that California likely would not receive enough federal stimulus funds to avoid deeper spending cuts and higher taxes triggered by the state budget signed last month — a budget that already imposes deep service cuts and substantial tax increases.
Under the budget agreement, the state must receive at least $10 billion in direct state aid for budgetary relief from the stimulus package to avoid almost $1 billion in additional cuts and an added $1.8 billion tax increase. The legislative analyst’s report estimated that just $8 billion of the $50 billion expected to flow into California would qualify as budgetary relief.
If that assessment is confirmed later this month almost $130 million in Medi-Cal funds would be cut by dropping certain benefits that are considered “optional,” including adult dental services, mental health services, podiatry and vision services.
Other cuts include a $54 million reduction to public hospitals achieved by a 10 percent cut in reimbursements, a $78 million state reduction to in-home care programs, a $268 million cut in payments to the elderly and disabled (SSI/SSP) through a 2.3 percent grant reduction. There would also be a $171 million cut in court operations, a $100 million cut to higher education and a $147 million cut to CalWorks welfare programs.
But the possible loss of Medi-Cal adult dental coverage could be devastating to community dental clinics that rely on that revenue to stay open.
“We would have to close because Medi-Cal payments for adults represents approximately 50 percent of our revenue,” said English, dental director of the Petaluma Health Center’s dental clinic. “Children who still have coverage would not be able to be seen.”
If the state stops funding adult dental care, the Petaluma dental clinic would lose $260,000, said Kathie Powell, CEO of the Petaluma Health Center. Powell said the Petaluma Health Center needs at least six full-time dentists to meet the needs of its 13,400 medical patients.
Joel Berryhill, dental director for the Sonoma County Indian Health Project in Santa Rosa, said the dental clinic also could lose 50 percent of its revenue for adult dental care provided to about 3,000 Native American adults and as many non-Native American adults.
Alliance Medical Center in Healdsburg stands to lose 25 percent of dental care revenue. The loss of the dental clinic would force patients to seek services at a larger clinic, such as the dental clinic at Alliance Health Center in Healdsburg, which is likely to weather the cuts. Alliance expects to lose about 25 percent of its Medi-Cal funding under the federal stimulus “trigger” language in the state budget.
Providers said many patients are likely to forego dental care until a painful abscess sends lands them in the emergency room.
“Some people try to pull out their own teeth,” Powell said. “They do, they pull their teeth out.”
About 13,500 people receive dental care at the six dental clinics run by Sonoma County community health centers, said Pedro Toledo, a spokesman for the Redwood Community Health Coalition, a network of nonprofit clinics in Sonoma, Marin, Napa and Yolo counties.
Toledo said the state calculates that local community clinics handled about 38,500 dental visits in 2007, with 46 percent of those being adult visits.
Kathy Ficco, executive director for community health for St. Joseph Health System in Sonoma County, said state cuts to adult dental would surely compromise the health of an entire community.
St. Joseph, which runs the dental clinic next to Southwest Community Health Center’s campus on Lombardi Court in Santa Rosa, said about 450 adult patients are served at the clinic and through a mobile dental clinic that operates four days a week and covers a wide expanse of Sonoma County.
The elimination of Medi-Cal coverage for adults would mean a loss of $40,000 for St. Joseph. “The number one concern is dental care, because it’s considered the hidden epidemic,” said Ficco.
Ficco and English said that periodontal disease has been linked to heart disease, can lead to premature and low-weight births and can make it far more difficult for a diabetic to control the illness.
At the West County Health Centers’ dental clinic in Guerneville, a cut in Medi-Cal funding for adult dental services would mean a loss of $300,000, half the clinic’s revenue, said Mary Szecsy, executive director of West County Health Centers.
The dental clinic, which has two full-time dentists and logs about 400 patient visits a month, also receives revenue from federal grants and sliding-scale payments from uninsured patients.
The cut would make it difficult to keep the Guerneville dental clinic open. “If we have to close these clinics, it’s going to take more time and more money to start them back up again,” Szecsy said.
She noted $350,000 in capital funding for the dental clinic came from state sources, including the California Health Facilities Financing Authority.
“We’d be unable to use those facilities the state funded to improve the health of our community," she said.
Michael Cohen, a deputy legislative analyst in Sacramento, said a meeting has been scheduled for March 17 between the director of the state finance department and the state treasurer.
He said that a determination should be made by then as to whether or not the state will reach the $10 billion threshold in federal stimulus funds. The cuts would take effect July 1 if the threshold is not met.
At the Petaluma dental clinic, Lewis, the construction worker, says it is a race against the clock to get his dental work done. He joked with English, a native of Romania and an Albert Schweitzer fellow who once worked in a refugee camp in Croatia.
“It might just turn out that Romania will have better dental care than we do,” said Lewis.
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