State officials promised new accountability after elected representatives, county supervisors, and advocates demanded better care for the more than 110,000 Sacramento County children who receive dental coverage through Medi-Cal, according to a story by the California HealthCare Foundation (CHCF).
The county operates the state's only mandatory managed care model, which has one of the state's worst records of care. Last year, less than one-third of Sacramento children with Medi-Cal saw a dentist, compared with nearly half of children on Medi-Cal statewide.
There have been many cases of children who have waited months or years to receive treatment for painful, rotted, or broken teeth.
According to the story, the director of the Department of Managed Health Care yesterday told lawmakers that his department is will review five dental plans that participate in Sacramento's managed care program, addressing access to care, quality of care, and other issues. The Department of Health Care Services (DHCS), which administers Medi-Cal, also has enforcement authority over the plans because it contracts with them directly to provide services.
In an ongoing dialogue, DHCS Director Toby Douglas told Senate President Pro Tem Darrel Steinberg, D-Sacramento, this week in a letter that the two agencies will coordinate oversight, according to the story. In his letter, he outlined a list of actions for dental plans to take to improve children's access to care, such as by sending letters to beneficiaries explaining benefits and calling beneficiaries to set up dental appointments.
Lawmakers say DHCS should give Sacramento families on Medi-Cal the temporary option to leave managed care.
Currently, the state pays the dental plans a monthly fee -- about $12 -- for each Medi-Cal child assigned to them, according to CHCF. The fee does not depend on whether the child actually sees a dentist. Critics of the program say the model discourages dentists from seeing patients because they get paid either way.
In contrast, most other county Medi-Cal children's dental programs in the state are "fee-for-service," with dentists being paid for each visit they report; lawmakers said Sacramento children should also have that option.
Critics have questioned why the situation has gone on for 18 years.
California also is embarking on a statewide expansion of managed medical care under Medi-Cal.
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