Health plans make profits by serving only 30% of kids
by Michael Monasky
Children dependent upon DentiCal, a MediCal spin-off serving the needs of the indigent, are having a hard time obtaining dental services in Sacramento County, according to local government officials. California State Assemblymember Richard Pan, a pediatrician, held a hearing Friday at the Capitol seeking further information from parents, health plans, practitioners, and politicians about the mandatory Geographic Managed Care (GMC) program and how it might restrict children from access to necessary services.
Registered Dental Hygienist Kate Varanelli runs the county SmileKeeper program. She said that she's seen children with bad teeth fail to thrive, like the abscess that made a young child listless, lose weight, and cease socializing. Varanelli said the lesson learned is that of “kids in pain” and the critical link between dental health and success in school.
Parents testified that their children with special needs were unable to obtain necessary and timely dental treatment. Alisa Erickson told the committee of her three-year ordeal seeking treatment for her then-14 year old daughter. She documented a combination of carelessness, cruelty, and denied coverage which has been “a nightmare.” Her daughter was recently treated at The Effort for her pain, and was told that the drugs prescribed to the child likely caused the dental caries she suffered.
Kethia Kirkaldy's nine-year-old daughter, who has cerebral palsy, was told she had a cavity last summer. Due to delays in issuing insurance cards and a failed referral system from primary care to the specialist she needs, she said she is still awaiting treatment. She said the recession has increased the number of “have-nots” and labeled the delays a “ridiculous process.” Dr. Pan noted the “lack of adequate response” for complaints and referrals.
Health plan representatives from Liberty and Health Net complained about parental non-compliance and clinic no-shows. They blamed lack of proper training for parents who put their children to bed with bottles of sweetened beverages. A California Dental Association spokesperson said “there is no silver bullet” and complained of low reimbursement rates and pressure to provide services at lower cost.
Former dental society chief Steven Cavagnolo declared that there is a reason why 70% of kids on DentiCal never see a dentist in Sacramento County. The health plans relied “on a model that only works economically with a rate of 30-35% utilization” which “rewards providers for delivering less care.” Cavagnolo, a dentist, said that reimbursement rates are very low, at $11 per child per month for the health plan, and $3 for service providers.
First Five commissioner Terry Jones said that “dentists are concerned about quality of care...coverage for infants through age three is dismal,” and that prevention is key to avoiding dental surgery. He added that his “dental colleagues say GMC should not be expanded throughout the state.”
Cynthia Weideman said she took DentiCal patients at first because she is “idealistic.” But after eight years of frustration with billing issues and duplications of tests, she had to dissolve the contract. She said she still sees kids for free, donating about $20,000 to $40,000 per year in services because GMC paperwork is more expensive to process.
Sacrament County Supervisor Phil Serna weighed in: that 93,000 kids receive no dental services; that the State should focus on outcomes, not whether GMC or fee-for-service is best; that there are existing dental resources for poor children at Federally Qualified Health Centers, like The Effort; and that consumer protection is needed with a “robust complaint system.”
Former Sacramento County Health Officer Glennah Trochet chronicled the 18 year history of the GMC DentiCal program and mentioned its two founding concerns: indigent access to care, and cost-containment. In the mid-to-late 1990's, a GMC commission helped initiate the program, but lack of transparency and data from health plans rendered the commission useless. It dissolved in 2003 with a final report.
The First Five Commission posted a scathing report, “Sacramento children deserve better; a study of GMC dental services,” in 2010. It prompted the Sacramento County Board Of Supervisors to ask its Public Health Advisory Board (PHAB) to intervene. Assemblymember Roger Dickinson said that GMC has a “checkered history” with lack of information for quality improvement, and that the report revealed “neglect of children.” PHAB issued its report last week which included ten recommendations to the California Department of Health Care Services, which oversees Sacramento County's GMC DentiCal. First Five program planner and social worker Debra Payne told the subcommittee that DHCS-DentiCal adopted only four of those suggested changes in its revised Request For Application (RFA).
Maternal-child nurse-consultant Barbara Aved, who drafted the First Five dental report, said “dentistry is always the stepchild of medical care, and that's still the case.” She declared California's GMC DentiCal as the “worst in the nation,” and that GMC was rejected by San Diego County. In her research for the report, Aved stated that she “darkened their [DHCS'] door” by making 34 data requests, discovering serious discrepancies between what was submitted by health care plans and published by DHCS. She said that GMC did not save any money as promised, and DHCS did not enforce any quality metrics for the program. Since GMC is a public contract, the Department of Managed Care Services did not monitor the program either.
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