Cleaning up, with teeth

Groups are zeroing in on the underperforming and wasteful county child-dental-health program

Brandon Mitchell says “ah” for Dr. Eugene Spenser at an elementary-school checkup earlier this summer. Local groups hope to force Sacramento County to overhaul its underperforming dental-care program as soon as possible.

Brandon Mitchell says “ah” for Dr. Eugene Spenser at an elementary-school checkup earlier this summer. Local groups hope to force Sacramento County to overhaul its underperforming dental-care program as soon as possible.


a toothless dental-care program that leaves poorer Sacramento County children underserved while dentists get paid for work they didn’t perform.

Launched in the mid-’90s as a pilot project to provide dental assistance for low-income children, the county program at the moment only assists 20 percent of the 117,000 eligible to participate. This has lead to a variety of health problems, more emergency room visits and also affects such things as school attendance and learning.

Meanwhile, area dentists are still receiving funds for child patients they’ve never treated.

“There are loopholes that allow dentists to get paid from the moment a child was born, even if they didn’t see the child,” explained Debra Payne, a program planner for First 5 Sacramento. “So now, we are working on closing those loopholes, and the state has said it is eager to help.”

Specifically, Sacramento-area dental organizations and the state hope to boost enrollment past the California average of 40 percent.

In July, a local coalition recommended that the Department of Health Care Services end contracts with low-performing dental plans, in addition to using secret-shopper programs to assess plan performance, rewarding plans that actually work with bonuses and making it easier for more health-care providers to participate.

But potential improvements still have to navigate Capitol sub-committees, survive input from the county board of supervisors and honor existing contracts with health-care providers and state law.

In all other California counties, Denti-Cal dentists are paid based on actual services provided. In Sacramento, however, participating dentists receive about $12 month per child, from birth and regardless of how often they see them as a patient. Perhaps not surprisingly, the resulting care has proven to be uneven, as Payne’s group documented in a report in 2010, “Sacramento Children Deserve Better” (see “Sacramento County’s toothache,” SN&R Frontlines, March 17).

Anthony Cava, a spokesman for the DHCS, told SN&R that this system “helps control costs and improve efficiency.”

Still, a coalition including First 5 Sacramento, the Public Health Advisory Board, the Sacramento County Children’s Dental Task Force and the Sacramento Health Improvement Project see room for improvement.

Dr. Glennah Trochet, co-chairperson of this task force and the county’s public health officer, outlined the recommendations to the DCHS in July, noting that, “[We are] extremely concerned about the low dental utilization rates by children of those services,”

She also pointed out the low rates of service among the five pre-assigned health-care-management providers contracted by the state. For instance, at the low end 5.5 percent of those assigned to Community Dental received at least one dental service a year, while in the most successful plan, 34.4 of those with Liberty Dental received one service.

Each of the five health care plans are all below the state average. For the other three plans, the percentage of users who visited a dentist at least once in 2008 are Access at 30.3 percent, HealthNet at 22.1 percent and Western at 11.5 percent.

The coalition is also asking that the state require participating dentists to see children by their first tooth or first birthday. This practice is recommended by the American Academy of Pediatric Dentistry, but, for Sacramento area Denti-Cal patients up to 3 years old, only 6 percent see a dentist once a year. The statewide average is 15.9 percent. Connecticut is considered the best among the states.

“The state is eager about working with us and improving services,” First 5 Sacramento’s Payne said. “So [the timeline] is a matter of months not years.”

Still, the state remains non-committal.

“It is a concern,” said DCHS’ Cava, adding he was unaware of the number of people in Sacramento County actually receiving care, “but there is no timeline.” He did also say that the current contract for the five Sacramento dental care providers ends on December 20, 2012.