In Marin County, a 75-year-old patient faced prolonged delays for dental care, resulting in the extraction of a decayed tooth. Despite being referred by Marin Community Clinics to a San Francisco dentist, the lengthy wait for authorization meant his tooth could not be saved. This marked the sixth time in ten years that the patient, who wears a denture, lost a tooth due to inadequate dental care. His denture complicates eating, leading him to avoid certain foods and causing embarrassment in social settings.
California is expanding its dental benefits for Medicaid recipients, but challenges remain. While the state offers comprehensive dental coverage for adults on Medi-Cal, many dentists do not accept the program. Data from the UCLA Center for Health Policy Research highlights that only 21% of California dentists treated Medi-Cal patients from 2019 to 2021, and even fewer accept adults, limiting dental care access.
Elizabeth Mertz, a professor of dentistry at the University of California, San Francisco, criticizes the program’s effectiveness. “You have coverage that is practically useless,” she states. “The state provides coverage, but very few dentists accept it.”
Current Medi-Cal coverage for dental implants is restricted to cases with “exceptional medical conditions.” A proposed bill by Democratic Senator Aisha Wahab aims to broaden coverage to include implants and crowns, potentially improving options for those with broken or missing teeth. The bill, which has already passed the Senate, is awaiting approval from the Assembly Appropriations Committee.
Despite the potential benefits, the Department of Health Care Services (DHCS) estimates that the cost of covering implants could be between $4 billion and $7 billion annually for approximately 1.5 million implants. This poses a challenge given California’s recent budget constraints, which include a significant deficit.
Cost estimates for implants vary widely, with reimbursement rates between $3,000 and $4,500 per implant, compared to typical costs of $4,000 to $4,800, and even higher in some locations like San Francisco. The California Dental Association has expressed concerns about the cost and complexity of implant procedures, advocating instead for coverage of routine cleanings and examinations.
DHCS has increased reimbursements and introduced measures to recruit more dentists into the Medi-Cal program, with over 40% of dentists participating as of July. However, access issues persist, with a significant portion of Medi-Cal patients failing to secure dental appointments.
During a June legislative hearing, the patient, identified as Moske, demonstrated the impact of inadequate dental care by showing his denture to lawmakers. Assembly member Reggie Jones-Sawyer, who also struggles with dental coverage, empathized with Moske’s situation and shared his own experiences with insufficient dental insurance coverage.
In summary, while California is working to enhance dental benefits for Medi-Cal recipients, significant barriers to access and affordability remain, highlighting the urgent need for comprehensive reform.
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