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HOME > ABOUT > PRESS > MEDI-CAL DENTAL COVERAGE CURTAILED
Article published - June 30, 2009
Credit: PRESS DEMOCRAT
Medi-Cal dental coverage curtailed
by Martin Espinoza
As of Wednesday, pulling bad teeth and deadening painful nerves are all that remain of Medi-Cal dental coverage for low-income and disabled adults.
As part of an effort to close the state budget gap — now estimated at $24 billion — the state will stop reimbursing dentists for fillings, root canals, crowns and other services formerly classified as “optional benefits” under Medi-Cal.
An exact number of patients affected was not available, but in 2007 the six community health clinics in Sonoma County handled 13,100 visits by patients under the optional benefits coverage, according to a clinics spokesman.
Non-dental optional benefits affected include psychology and podiatry services, acupuncture, audiology and speech therapy, chiropractic and optometry and optician services.
“These optional benefits are not optional, they’re critical services,” said Mary Szecsey, executive director of West County Health Centers.
The elimination of optional benefits, as laid out in the state budget that was signed in February and now is being revised as the deficit has grown, will save the state $110 million, said Tony Cava, a spokesman for the state department of health care services.
Medi-Cal is California’s version of the federal Medicaid program.
“We’re only one of six states offering adult dental under Medicaid programs,” Cava said. “Unfortunately, due to state’s budget situation, difficult decisions were made on which programs to reduce.”
Although all medical providers who accept Medi-Cal coverage will be impacted, community clinics will be particularly hurt because of their large number of Medi-Cal patients.
For the time being, local clinics will attempt to absorb the blow and continue providing these services to Medi-Cal patients, said Pedro Toledo, a spokesman for the Redwood Community Health Coalition, a network of clinics and community health centers in Sonoma, Napa, Marin and Yolo counties.
“We’ll continue to provide services at a sliding fee scale and we’ll do our best to meet their needs,” Toledo said.
Last week, a Superior Court judge in Sacramento rejected a lawsuit aimed at stopping the cuts to optional benefits. It was brought by the California Primary Care Association.
Szecsey, of West County Health Centers, said Med-Cal reimbursements for adult dental services make up half the dental clinic’s revenues, or about $250,000.
“It doesn’t seem like a lot, but it provides a lot of services for a lot of people, thousands," she said.
With the loss of adult dental services, the dental clinic’s uninsured burden will increase from 40 percent to 90 percent, she said.
“We’re going to be looking at having to subsidize the cost of those services with revenues from other sources,” Szecsey said.
Of the 4,000 “dental encounters” last year at West County Health Center’s dental clinic in Guerneville, 30-to-40 percent were adults covered by Medi-Cal.
Szecsey and other community clinic leaders said the cuts could eventually force her to scale back her dental program, a move that could affect Medi-Cal services for children, which the state continues to fund.
“Eventually what will happen is we will not be able to fund these services and we’ll have to cut services for all patients,” Szecsey said.
On Tuesday, Szecsey joined a number of health care providers, community clinic advocates and Medi-Cal patients to protest the cuts.
The state Department of Health Care Services has prepared a Web-site that lists cuts in optional benefits cuts, along with an explanation of special circumstances that can allow services to be reimbursed: http://www.dhcs.ca.gov/services/medi-cal/Pages/ReductionMedi-CalBenefits.aspx.
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