During a press conference today at Dominican Hospital, Dientes Community Dental Care and Salud Pan La Gente announced that on July 1, 2009 thousands of low-income Santa Cruz County residents and more than 2.8 million adults statewide will lose access to vital health care services due to the elimination of Medi-Cal “optional” benefits in the recently-enacted state budget.

These Medi-Cal benefits are termed “Optional” because, while federal law mandates tat states provide certain medical services, as to other services federal law provides the states with an “option” to provide or decline to provide the services. So-called “optional” benefits which have been eliminated by California include adult dental, optometry, podiatry, audiology, speech therapy, psychology, chiropractic and acupuncture.

Elimination of Medi-Cal optional benefits will drastically reduce access to health care services for the most vulnerable patients in Santa Cruz County. Clinics and health centers will be forced to restructure services and lay off staff in response to the loss of millions of dollars of Medi-Cal reimbursements. Not only will this mean 20,000 individuals in Santa Cruz County will lose access to desperately-needed health services, but also will result in health care sector job cuts and fewer dollars for our local economy.

“Medi-Cal optional benefits are quite simply not optional and especially dental benefits,” said Will Hahn, Executive Director of Dientes, one of the Santa Cruz County impacted clinics. “Dental health is absolutely critical to overall health. This recent action will jeopardize clinical programs across this state, including the one here at Dientes.”

Medi-Cal adult dental services comprise nearly 40 percent of the revenue community clinics statewide use in operating their full dental programs. Eliminating optional benefits will not only have a devastating impact on millions of adults, but will also jeopardize the ability of community clinics to provide federally-mandated services to children, will increase hospital emergency room visits and will reduce participation by heath care providers in the Medi-Cal program. Hospital emergency rooms are not equipped to treat root causes of pain and infection caused by underlying oral health conditions, which are preventable and treatable in a dental office.

Elimination of Medi-Cal optional benefits will reverberate far beyond community clinics and will far outweigh any short-term dollar gains. Economically, the consequences of this cut will be increased long-term health costs to the state. Medically, the elimination will mean poor health outcomes and more medical problems in low-income, disabled and elderly adult patients due to lack of primary preventive care and treatment in these vital areas.

“Oral health status not only affects a person’s overall health and well-being, but also one’s employability and economic vitality,” said Dr. Jóse A. Chibrás, Chief Medical Officer at Salud Para La Gente. “Health care professionals across the board have long recognized that adverse health outcomes arising out of poor oral health include not only avoidable pain and suffering, but also respiratory disease, diabetes, stroke and heart disease. Poor oral health also leads to loss of employment and reduced work hours due to ailments and associated dental visits.”

Various of the propositions on the May 19, 2009 special election ballot are designed to generate revenue to reduce the state’s budget deficit. “Whether or not the propositions pass, the Governor and the Legislature must act to prevent the health care crisis which will result from the elimination of Medi-Cal optional benefits,” said Hahn and Chibrás.

 

The following information is provided by CPCA (California Primary Care Association) and Dientes Community Dental Care

• The budget enacted by Governor Schwarzenegger and the Legislature eliminated Medi-Cal Optional Benefits. Optional benefits include adult dental benefits, chiropractic care, incontinence creams and washes, acupuncture, audiology, optometry, opticians and optical labs, podiatry, speech therapy and psychology services.
• The loss of optional benefits will likely impact more than 20,000 adult Medi-Cal beneficiaries in Santa Cruz County alone, and some 2.8 million beneficiaries statewide impacting the elderly, the disabled, low-income workers and unemployed families. The adult Denti-Cal program is by the far the largest optional benefit.
• Denti-Cal coverage includes diagnostic and preventive dental services, emergency treatment for control of pain and infection, fillings and tooth extractions, root canal treatments, and prosthetic appliances (e.g., dentures). Dental services for adults are already limited by being capped annually at $1800.
• Medical research clearly shows that oral health and physical health are inextricably linked, as oral diseases can have systemic effects. Untreated oral health problems are associated with a variety of adverse health outcomes, including diabetes, stroke, heart disease, bacterial pneumonia and preterm and low birth weight deliveries. Left untreated, dental disease or medical conditions resulting from dental disease can also lead to death.
• A study of Medicaid families revealed that when parents do not make at least one dental visit annually, their children are 13 times less likely to visit a dentist that same year. This and other studies underscore the importance of ensuring that low-income adults have access to dental services not only for their own health and wellness, but also for their children’s wellbeing.
• While the elimination of adult dental benefits will purportedly save money in the state budget the costs to patient health and the stability of the safety net far outweigh any potential savings.
• The state also stands to lose $115 million in federal matching funds, according to the Oral Health Access Council. The federal government currently provides a 50-50 match in funds toward Medi-Cal. The $10 billion in extra Federal Medical Assistant Percentage (SMAP) funds would bring the federal government’s share up to about 60 percent.
• Reducing such critical Medi-Cal services as adult dental will only exacerbate overall health conditions for the population with the greatest need for dental services, and those most vulnerable to oral health complications, and result in severe damage to the safety net.
• Elimination of adult dental benefits will result in a drastic reduction of our clinics’ dental programs, including dental services for children and non-Medi-Cal populations.
• Without dental coverage, patients will be forced to utilize costly hospital emergency rooms which are ill-equipped to provide more than extractions, antibiotics and pain medication.
• Denti-Cal is the primary payer source for most clinics and it comprises nearly 40% of the revenue community clinics statewide use in operating their full dental programs. The number of adults served by community clinics is 37% on average and these clinics receive approximately $56.5 million in Medi-Cal from adult dental patients.
• In CY 2008, Dientes and Salud Para La Gente treated 3,074 adult Medi-Cal patients with 11,514 visits. Combined, the adult dental visits account for over 25% of these dental programs. If optional benefits are eliminated, these clinics and our community stand to lose newly $2 million in Medi-Cal reimbursement for healthcare services that our patients desperately need.
• According to the California Primary Care Association, when Maryland eliminated its adult dental benefits program in 1993, emergency room visits for dental issues rose 21 percent in one year. Similarly, when Massachusetts eliminated its Medicaid adult dental benefit, community health centers found that they could not accommodate the large influx of new patients.
• As of July 1st, clinics will be forced to take $56.5 million hit that will mean a loss of dental coverage to patients and potential layoff of clinic employees. The $48 million California clinics just received in stimulus from the Increased Demand for Services means clinics can see 300,000 new patients and only retain 896 jobs —well below what the budget cuts to Denti-Cal are costing clinics.
• The elimination of Medi-Cal funding for adult dental will result in jeopardize the health of millions of Californians, increase the burden on an already fragile health care safety net, increase health care costs, and force layoffs of staff and longer wait times at community clinics and health centers. Statewide, the elimination of adult dental will cause the loss of an estimated 4,240 jobs.
• In addition to the elimination of adult dental services, the Department of Health Care Services, which administers the Denti-Cal program, has also been instructed to reduce reimbursement rates to providers by 10 percent, which will further reduce access to care for children and other beneficiaries.
• Policymakers have a chance to restore Medi-Cal optional benefits, including adult dental. We urge Governor Schwarzenegger and members of the Legislature to reconsider this elimination, and fully restore Medi-Cal optional benefits before July 1, 2009.
• On April 29, 2009, CPCA in conjunction with member clinics Clinics del Camino Real (Ventura County) and Southern Trinity Health Services (Trinity County) filed a Writ of Mandate (Writ) in the State Superior Court of Sacramento County.
• The Writ contends that FQHC/RHCs are exempt from cuts to dental, chiropractic, optometry, podiatry, and psychology services on the grounds that these services are core FQHC/RHC services according to state and federal law, and orders that the State must reimburse FQHCs/RHCs for these services.
• According to California’s Medicaid State Plan - which is essentially the contract between California and the federal government in administering the state’s Medicaid program - the state is required to reimburse FQHCs/RHCs for services provided by a core provider.
• Consistent with Federal law, California’s definition of “core providers” includes the services of dentists, chiropractors, optometrists, podiatrists and psychologists as FQHC core providers.
• Despite the state’s effort to eliminate Medi-Cal optional benefits, the fact remains that the key state and federal statutes defining clinics’ reimbursement structure remain intact and were not altered by the budget bill.