Community Voices

Sunday, Oct 27 2013 11:00 PM

VICKIE KASPRZYK: Dental care for low-income kids imperiled by Medi-Cal cuts

Dental surgery centers that fill cavities and restore teeth for thousands of low-income children could close in the San Joaquin Valley -- and that includes Kern County -- unless the state grants an exemption from Medi-Cal cuts.

All Kids Dental Surgery Center on Eye Street is not an exception. They face a 10 percent Medi-Cal cut and a retroactive pay cut of another 10 percent. The state is basically going to put all 18 surgery centers throughout California out of business.

The dental centers are among health providers in California that are subject to Medi-Cal cuts under Assembly Bill 97, approved by the Legislature in 2011. Provider lawsuits delayed the cuts, but the centers started getting reduced payments last month after federal courts ruled in the state's favor.

Now the surgery centers are awaiting word from the state on when they have to return more than two years' worth of reimbursements.

The centers provide dental care for children who are too young, too scared or have too much dental decay to be treated at a regular dental office. At the centers, the children are sedated so they are not traumatized and to allow dentists to undertake multiple procedures in one sitting.

If the surgery center in Bakersfield is forced to close or severely cut back, more children will have to travel to Los Angeles for treatment. Many more will need to go to hospital emergency departments in pain. State officials say safety-net clinics are available to children, and the state will monitor the effects of the Medi-Cal cuts on access to care.

Every day, we see children who need more than half their teeth treated with fillings, crowns or extractions. I am talking about kids who have 20 rotting teeth.

We see 30 to 50 kids like this per month.

Surgery centers say they're especially vulnerable to the cuts because a large percentage of their patients are on Medi-Cal. Those patients may represent only 20 percent of the caseload at typical dental offices, which can rely on private insurance payments from the majority of patients.

With AB 97, the state granted an exemption to a not-for-profit center in Sonoma County, citing the need to "preserve and protect access to care for Medi-Cal members." The exemption for the for-profit surgery center must be approved by the Federal Center for Medicare and Medicaid Services, and for-profit centers want to be included in that exemption. Sparing only one center from the reimbursement reduction will not ensure access for children throughout the state.

Officials with the Department of Health Care Services, which oversees Denti-Cal, said the Sonoma center was exempted from the reimbursement reduction because "of the urgent nature of the dental visits/services rendered to the populations they serve."

Surgery center owners say they have operated for years on low reimbursements from the state, and at least one center in Fresno closed before the 10 percent cut from Medi-Cal.

The for-profit centers' appeal for an exemption has the support of Assemblyman Adam Gray, D-Merced. His letter Oct. 10 to state health care services director Toby Douglas was co-signed by state Sens. Anthony Canella, R-Ceres, and Cathleen Galgiani, D-Livingston, and Assemblywoman Kristin Olsen, R-Riverbank.

This is about children. The work these dental surgery centers do in not only essential to the well-being of some of the valley's most underserved populations, it saves the state millions of dollars in the long run by avoiding myriad trips to costly hospital emergency rooms. The exemption is justified and necessary.

Vickie Kasprzyk, R.N., co-founded Fresno Dental Surgery Center in 2006 and All Kids Dental Surgery Center in Bakersfield in 2012. Community Voices is an expanded commentary of 650 to 700 words. The Californian reserves the right to edit all submissions for length and clarity.

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