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06/11/2013

CDA wins Adult Denti-Cal spot in budget deal


The move to restore adult Denti-Cal benefits is one step closer to reality after the governor and state lawmakers agreed to include funding in a preliminary budget deal.

The restoration of benefits, which still needs final budget approval, would begin in May 2014, with a proposed annual cost of $77 million. The coverage includes preventive care, restorations and full dentures, but does not include partial dentures. CDA believes it includes endodontic services on a case-by-case basis but is awaiting full coverage details. 

“This is a significant achievement in the effort to restore all adult Denti-Cal services 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 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.”

Restoring Adult Denti-Cal, a top priority for Senate President Pro Tem Darrell Steinberg (D-Sacramento) and other key lawmakers, is the only substantive ongoing restoration of a health program included in the entire state budget.

“Restoring dental care for the uninsured … reduces overall health care costs and helps more Californians to find employment,” said Steinberg, who has been a champion for bringing back Adult Denti-Cal after seeing the tremendous need firsthand at the CDA Cares free dental clinic in Sacramento last year.

The news comes on the heels of a recent vote of confidence by the Senate Budget and Fiscal Review Committee. Four years after the program’s elimination, the committee voted 14-0 on May 24 to fully restore Medi-Cal adult dental benefits. Sen. Bill Monning (D-Carmel), who had visited CDA Cares San Jose in May, also 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.

“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.

“I think that there is a way to fund this program without putting a hole in the budget,” said Sen. Bill Emmerson, DDS, (R-Redlands) during the hearing.

Court Decision on Medi-Cal Reimbursement Rates

Meanwhile, in a disappointing move on the same day as the committee’s vote, the U.S. 9th Circuit Court of Appeals denied a petition filed by CDA and a coalition of health care organizations aiming to stop the state from implementing a 10 percent reduction in Medi-Cal provider reimbursement rates. The decision essentially allows the state to implement a 2011 law that cuts Medi-Cal reimbursements to dentists, physicians, pharmacists and other Medi-Cal providers. Because the cuts have been blocked by court injunction since June 2011, the ruling would allow the state to recoup a portion of payments made to providers since that date.

CDA is participating with a coalition of health care providers, which includes the California Hospital Association, in filing a motion requesting a Stay of the Mandate. The request is an attempt to ask the U.S. 9th Circuit Court of Appeals to stop moving forward with the cuts. The coalition also is evaluating next steps and appropriate legal challenges.  

The court’s decision also has implications for the discussions on restoring adult Denti-Cal services due to the fact the cuts will make it far more difficult for providers to participate in the program. CDA is working to fully understand the court’s decision and its impact on state efforts to recruit more dentists to become Denti-Cal providers.

CDA will keep members informed on the developments and provide more information as it becomes available.

For more information on Denti-Cal, visit the Major Issues page.