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CDA asks state to fix problems in dental benefits program

January 05, 2015 Sacramento, Calif. — The California Dental Association is urging its state government to immediately address critical issues within its dental benefit program under Medi-Cal, which it says is failing to provide adequate access to care for millions of low-income children.

An audit issued by the California Bureau of State Audits stated that nearly 56 percent of the 5.1 million children enrolled in Denti-Cal in 2013 did not receive any dental care that year. The report also stated there is a lack of providers in a number of California counties, including five with at least 2,000 children in the program that may not have had any active dental providers.

Denti-Cal is the state program that administers free or low-cost dental care to low-income or uninsured children in California. The audit, "California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care" is available at auditor.ca.gov/pdfs/reports/2013-125.pdf.

"For years, CDA has advocated for action to correct the critical lack of access to care for children enrolled in the Denti-Cal program, and this audit shows just how serious the crisis is," said Dr. Walt Weber, CDA president. "Dental disease is the number one chronic childhood disease and one of the top reasons children are absent from school. We need to ensure they can access the care they need to be healthy."

The auditor's report attributed Denti-Cal's low reimbursement rates, ranked among the lowest in the nation, as one of the primary reasons for the lack of providers participating in the program, according to a CDA news release. It noted that the state's reimbursement rates, which have not increased since 2000, are 35 percent below the national average, with the 10 most common procedures authorized for payment averaging $21.60.

Additionally, the state's 10 percent Medi-Cal rate reduction implemented in 2013 applied to pediatric dental providers, while nondental pediatric providers were exempt from the cuts.

The CDA is asking the state to reverse the 10 percent reduction and increase reimbursement rates.

The report, which also criticizes the Department of Health Care Services for inadequate oversight of Denti-Cal, expresses serious doubts about Denti-Cal's ability to accommodate millions of new children and adults who gained coverage through eligibility expansion, according to a CDA news release.

"The state has a responsibility to ensure there is an adequate network of dentists to provide needed care, but the low reimbursement rates mean dentists have to provide care at a loss, and unfortunately, many who would like to participate in Denti-Cal are unable to do so," Dr. Weber said.