Young people who don't get the routine dental care they need find themselves at a disadvantage, studies have shown: not just in overall health but also in school performance.
Now a study from the Pew Charitable Trusts finds that California is among the 10 states where low-income children are least likely to receive dental care.
Almost 60 percent of children with Medi-Cal did not receive any dental care in 2011, said co-author Jane Koppelman.
"What it means is that kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement," says Koppelman, research director for the Pew Children's Dental Campaign. "It’s a license to try to find a dentist who can give you care. And in a lot of areas that is quite a trial.”
Koppelman said there are a number of reasons why pediatric dentists who take Medi-Cal are few and far between. For one, some dentists don't want to deal with the hassle factor that comes with being involved in a paperwork-intensive public program. But Koppelman also points to low reimbursement rates.
Ellen Espejo, director of media and health policy at Children Now, agrees.
"Given that California has one of the lowest reimbursement rates in its Medicaid program, it's unfortunately not surprising," said Espejo.
In fact, the portion of kids on Medi-Cal who weren't seen by a dentist in California increased between 2010 and 2011, from 57.7 percent to 58.6 percent.
"This is definitely an ongoing problem with the threat to escalate," Espejo said. "The budget before the governor now has a 10 percent reimbursement rate cut that would affect dentists."
The reimbursement cuts to Medi-Cal have been the subject of protests in Sacramento by health professionals this month as the budget inches closer to being signed by the governor.
There has been some good news for adults using Denti-Cal, the dental arm of Medi-Cal. Nonemergency dentist benefits were partially reinstated for the coming year after being cut out in 2009. But Espejo said for kids the issue is more than just coverage and having providers signed up. It's about having providers that are also able and willing to work with kids.
"There are general dentists that accept Medi-Cal," Espejo said. "But the issue from the children’s perspective is that these general dentists may not be well trained or staffed to see children."
Getting children in the door early is key to the long-term benefits of dental care, said Nadereh Pourat, a professor at the UCLA School of Public Health.
"You want the kids to get early care to prevent cavities. They don’t get that and then they are set up for problems later on,” Pourat said.
Pourat said the fact that children are not being seen is all the more frustrating because it requires a relatively small outlay of money. ”When you talk about preventive care for children you’re talking about really inexpensive care ... sealants and fluoride, and about teaching them how to clean their teeth,” she says.
Pourat said there is also an element to the story that raises questions about the factors that are necessary to make sure people actually receive health care.
“Coverage is supposed to be the No. 1 facilitator to access and here are all these kids not getting access,” said Pourat.
The intersection between coverage and access is at the heart of the Affordable Care Act. Pew study author Koppelman said the lack of dental access for low-income California children is important to keep in mind as the state faces a time when expanded private insurance coverage could mean even more competition for pediatric dentistry resources.
"The provider shortage is not a new story," Koppelman said. "What’s new is that it’s not getting better, and it’s not getting better at a time when we’re going to see an influx of millions more children into the dental delivery care system."
The state's health exchange, Covered California, is scheduled to release information about pediatric dental plans today.