UPDATE, March 23, 2012: Darrell Steinberg, CA Senate President Pro Tem (D-Sacramento) received a unanimous approval by the Senate budget committee on health and human services for his proposal to give Sacramento County children on Medi-Cal a choice of health-care providers for dental coverage, rather than using the County's mandatory managed care system, reports the Sacramento Bee:
The legislation also would establish stricter standards for dental plans and tougher enforcement by state agencies.
Steinberg said the legislation is necessary because Sacramento County's mandatory managed care dental program, the only one of its kind in the state, has left some children waiting months for treatment for painful, rotted or broken teeth.
Steinberg wrote to Douglas last week calling for a review of the "geographic managed care" dental program after the story by Center for Health Reporting featured in the Bee on February 2, 2012, that described the shortcomings of the managed care program (see below: previously reported)
... Douglas promised quicker resolution to complaints from patients and said the department will get tougher on dental plans that fail children, either by withholding payments or by terminating their contracts....
Douglas said it would be "most expedient and effective" to keep Sacramento kids in the managed care program rather than shifting them into fee-for-service, in part because the state would have to alter agreements with the federal government, which provides some Medi-Cal funding.... his department is reviewing existing contracts and preparing to beef up new contracts, which take effect between July 1 and Jan. 1...The contracts will contain performance measures that will allow DHCS to "terminate plans for poor performance or failing to meet responsibilities," he wrote.....
Debra Payne, health and dental program planner at First 5 Sacramento, added that Douglas' letter didn't address other important issues. For one, Payne said, the plans are paid to see children from birth to age 3, yet most don't. She also wonders why Sacramento children on Medi-Cal must remain part of a mandatory managed care plan. "Why couldn't it be made voluntary?" much as it is in Los Angeles County, she asked.
In 2010, First 5 published "Sacramento County Children Deserve Better, 2010" a report critical of the dental program and has been working with DHCS to improve care.
February 12, 2012: Yesterday's Sacramento Bee featured a story by Jocelyn Weiner from the Center for Health Reporting revealing that the 18-year-old, state-mandated "model" program that relies on a "geographic managed care" system to deliver dental services to poor children in Sacramento County "has consistently produced one of California's worst records for care."
Participation in the program, in which the state pays five private dental plans $12 a month per eligible child -- whether they see a dentist or not -- and there are 110,000 Sacramento children who Medi-Cal qualified (last year, the state paid these five plans a total of nearly $20 million). Let's do the math: that's $1.32 million a month, again: whether these children are seen or not. And in 2010, only 30.6% of the eligible children in Sacramento County saw a dentist, compared to nearly 50% of their peers in the rest of the state, where dentists bill Medi-Cal for visits.
[In 2010-2011, Sacramento County] ranked third worst in terms of the percentage of kids who got care in the state – above only rural Alpine and Trinity counties. During the three previous years, it was the state's lowest performing children's dental system, state numbers show.....
Critics – including local dentists, county officials, school nurses and family members – contend that Sacramento's special model of care forces many children to wait months or even years before receiving needed treatment, even if they have broken or rotting teeth, or are in so much pain that they can't chew.
Among the examples they cite is 6-year-old Christina Romero, who was told by her dental office that she would have to wait more than a month for treatment, even though she had a fever and a toothache so severe it was causing her to miss school, her mother and school officials said.
They point to 18-year-old Stephanie Erickson, who endured a painful broken tooth for years while her mother says she begged dental offices to perform an extraction.
And they talk about 4-year-old Julian Flores, who for two years regularly cried in pain while eating before his mother says she was finally able to receive the authorization necessary to get root canals on all 20 of his baby teeth....
"Kids aren't being seen," said Cathy Levering, executive director of the Sacramento District Dental Society, a professional group that represents 1,545 dentists in the Sacramento region.
Levering said that, because of low reimbursement rates, mountains of paperwork and other bureaucratic headaches, many Sacramento dentists won't participate in Medi-Cal at all. She said many are also turned off by a geographic managed care system they consider "broken."...She said she is particularly concerned about the large number of offices that refuse to see very young children. According to one survey she conducted, 44% of dental offices that participate in geographic managed care wouldn't see a child until age 3 – despite the fact that the state pays them to see children from infancy.
The issue was raised last year by Sacramento First 5, in a report "Sacramento Children Deserve Better."