Legislature approves restoring Adult Denti-Cal

The move to restore Adult Denti-Cal benefits is one step closer to reality after the Legislature voted on a new state budget plan. The proposed budget, which still needs the governor’s signature, provides funding for the restoration of Adult Denti-Cal benefits slated to begin in May 2014, with a proposed annual cost of $77 million. The coverage includes preventive care, restorations and full dentures.

Lawmakers cited the CDA Foundation’s CDA Cares free dental clinics as a stark example of the tremendous need.

“I will never forget the sea of people – the endless lines of low-income Californians – some of whom had waited overnight,” said Senate President Pro Tem Darrell Steinberg (D-Sacramento), who made the restoration of Adult Denti-Cal a top priority after his visit last August to CDA Cares in Sacramento. “It wasn’t just to get their teeth cleaned or fill a cavity, but for surgery to deal with abscessed teeth, root canals and replacement of missing teeth. I saw people who had lost all their teeth because they can’t get preventive dental care.”

“This is a significant achievement in the effort to restore essential dental services for low-income adults and a step in the right direction to address the oral health care crisis facing millions of Californians,” said CDA President Lindsey Robinson, DDS. “We appreciate the support of the Legislature and the leadership of Senator Darrell Steinberg, Assembly Speaker John Perez and Governor Jerry Brown in recognizing the need to restore dental services for low-income Californians who experience barriers to oral health care.”

Steinberg said he was stunned by what he saw at CDA Cares and decided to make it his mission to restore Adult Denti-Cal in the next fiscal year. In addition to preventive care and restorations, Steinberg felt it was important to include full dentures in the coverage to help the employment prospects of edentulous Californians.

“In dental care, there are issues of both health and economics,” said Steinberg. “By restoring adult dental care benefits to include full dentures, we can restore health as well as the confidence people need to get back into the workforce and to go out and apply for a job with pride.”

Prior to the Legislature’s approval, the effort to restore Adult Denti-Cal received a unanimous vote of confidence by the Senate Budget and Fiscal Review Committee, which voted 14-0 on May 24 to fully restore Adult Denti-Cal benefits.

Sen. Bill Emmerson, DDS, (R-Redlands), served as the vice chair of the committee and supported efforts to restore Adult Denti-Cal.

“I think that there is a way to fund this without putting a hole in the budget,” said Emmerson during the hearing.

Sen. Bill Monning (D-Carmel), who had visited CDA Cares San Jose in May, cited the event as direct evidence of the extent of the oral health care access crisis in California.

“There were thousands of people who turned out for basic dental care, extractions and dentures. And thanks to the volunteerism of the dental community and the broader community, people received services,” Monning said.

Monning also commented on the fact that not restoring Adult Denti-Cal services would not save the state money in the long-term because patients end up in emergency rooms for dental care.

Since 2009, after the elimination of virtually all Adult Denti-Cal services for 3 million people, an increasing number of people have sought emergency dental care at hospitals, which have no dentists and can only provide antibiotics and medications for pain at a cost much higher than preventive care.

“The time is right to restore, fully, the Medi-Cal adult benefit,” Monning said. “We know anecdotally in our communities, not having access to adult Medi-Cal dental services doesn’t result in people not seeking treatment, they just end up seeking it in emergency rooms once they have an abscess and we end up paying way more than if we had in place good, preventive help in prevention and services.”

Anthony Mock, DDS, is the clinic director at Highland Hospital Dental Clinic and chief of general dentistry and special needs coordinator at Alameda Health Systems. Highland, a level II trauma center and safety net for medical and dental services in Alameda County, sees 75,000 general patients in the emergency room each year. 

Mock testified before the committee and explained that after 2009, when the Adult Denti-Cal program was cut, the hospital saw a surge in patients needing emergency dental care. Mock noted that between 2007 and 2011 Highland saw a 94 percent increase in dental patients in the emergency room.

“The cost of treating dental problems in the emergency room is high — much higher than it would be in a local dental office or even in our drop-in dental clinic. The average cost for an ER visit is $1,600. So in 2007, dental patients received $3.8 million of treatment in the ER and in 2011, that figure jumped to $7.5 million on average,” Mock said. “And we are just one hospital. To accurately calculate this cost to the system, you will need to extrapolate these figures to every ED in every hospital around the state.”

According to the committee staff report, with the expansion of Medi-Cal to certain childless adults, under federal health care reform, the state could take advantage of the 100 percent federal funding (for the first three years) for new enrollees. The federal government would be paying for 100 percent of the costs associated with the restoration of adult dental services for the newly eligible.

The state budget calls for the implementation of the Adult Denti-Cal program for May 1, 2014.

“It allows plenty of time to get this program up and running,” said Steinberg. “After being gone for four years, it’s going to take some time to rebuild this essential program, and to make sure it’s done right.”