This year is bringing substantial changes to California’s health-care program for low-income residents, particularly new limitations on Medi-Cal eligibility for enrollees with “unsatisfactory” immigration status.
One casualty of those changes will be a loss of much of the dental care available to undocumented adults – care that can prevent a range of broader health problems and have what the California Dental Association called “devastating impacts” for many people and a reduction of access to dental care for Medi-Cal enrollees overall.
In the San Joaquin Valley, where about half of the population is enrolled in Medi-Cal and there is already a lower ratio of dentists per 10,000 residents than the rest of the state, the impact is likely to be felt even harder.
Over recent years, California has used its own state dollars, rather than federal Medicaid allocations, to open “full scope” Medi-Cal enrollment to all income-eligible residents regardless of immigration status. Federal law largely prohibits undocumented immigrants from receiving benefits paid for by Medicaid, but California used its own budget to finance expanded Medi-Cal eligibility and offer coverage to low-income, undocumented residents ages 19 and older.
California is one of only seven states in the U.S., plus the District of Columbia, that offers public health coverage to some or all low-income adults regardless of immigration status, and one of 14 states plus D.C. that provides coverage for children regardless of their immigration status, according to KFF, an independent health policy and information organization..
Medi-Cal’s full-scope dental covers routine diagnostic and preventive care such as examinations, X-rays and cleanings; fillings and tooth extractions; and more complex needs, including root canals, crowns, periodontal maintenance, dentures, and orthodontics for children.
But in a few months, undocumented Medi-Cal dental patients ages 19 to 54 will only be allowed to receive coverage for emergency dental care such as pain control, X-rays, cleanings, fillings and tooth extractions.
“Starting July 1, 2020, some Medi-Cal members will stop getting full-scope dental services as part of their coverage due to changes in state law,” the state Department of Health Care Services told the Central Valley Journalism Collaborative in a written statement.
The reduction in coverage was part of the California state budget approved last summer but will kick in this year. The state estimates that the dental limitation will save about $308 million in the 2026-27 budget year, and $336 million per year going forward.
Impacts on overall health, access to care
Dental health involves more than the appearance of one’s smile and chewing food. The U.S. Centers for Disease Control and Prevention or CDC and the U.S. Public Health Service have noted that oral or dental health are connected with overall health.
Poor oral health can worsen blood sugar control in people with diabetes, the CDC reports, and “a growing number of studies show that people living with certain chronic conditions more often have untreated oral diseases or conditions.”
The U.S. Public Health Service, in a 2000 report on oral health in America, also stated that “studies have reported associations between oral infections – primarily periodontal infections – and diabetes, heart disease and stroke, and adverse pregnancy outcomes ….”
In a statement to the Central Valley Journalism Collaborative, the California Dental Association cautioned that the short-term savings could result in long-term consequences when it comes to dental-care access for low-income patients and related health concerns.
“The proposed changes and funding cuts to the Medi-Cal dental program would have devastating impacts on our state’s most vulnerable populations, forcing them to forgo or delay basic dental care and driving completely preventable emergencies into overcrowded [hospital] emergency departments,” said Robert Hanlon, DMD, the association’s president.
“It is appalling that when the cost of providing healthcare is at an all-time high, the state is considering cutting program funding back to 1990s levels,” Hanlon said.
Of about 30,000 dentists in California, about 40% accept Medi-Cal patients. But that could decline precipitously in the wake of the Medi-Cal cuts. Hanlon said a recent California Dental Association survey of Medi-Cal providers, “49% of respondents said they would be forced to leave the Medi-Cal program entirely, and another 30% reported they would be forced to see fewer Medi-Cal patients if the state implements these cuts.”
The potential flight of dentists from Medi-Cal participation is at least partially because reimbursements from the program often fall short of what it costs to provide the care. If the association’s survey is accurate, that would put a huge damper on access to dental care for low-income patients, whether undocumented or not, in the San Joaquin Valley where about half of the population is covered by Medi-Cal.
The region already has a relative shortage of dentists compared to the rest of the state. Data from the Dental Board of California indicates there are about 2,200 licensed, active dentists practicing in the San Joaquin Valley. That translates to about five dentists per 10,000 residents – about one-third less than the 7.6 dentists per 10,000 residents statewide.
How many people will be affected?
About 2.1 million residents across the San Joaquin Valley, from San Joaquin County in the north to Kern County in the south, are covered by Medi-Cal, the state Department of Health Care Services reported in September. That includes about 156,000 people ages 19 and older who have been eligible for Medi-Cal benefits under California’s expansion of benefits to undocumented residents.
By county, the number of residents to be affected by the denial of full-scope dental benefits are:
- Fresno County: Of 318,350 Medi-Cal eligible adults, 30,635 are enrolled through the expansion, or about 9.6%.
- Kern County: Total 295,425 Medi-Cal eligible adults, including 36,673 under expansion, or 12.4%.
- Kings County: Total 39,913 Medi-Cal eligible adults, including 3,627 under expansion, or 9.1%.
- Madera County: Total 49,262 Medi-Cal eligible adults, including 8,492 under expansion, or 17.2%.
- Merced County: Total 87,706 Medi-Cal eligible adults, including 10,724 under expansion, or 12.2%.
- San Joaquin County: Total 194,876 Medi-Cal eligible adults, including 22,012 under expansion, or 11.3%.
- Stanislaus County: Total 158,170 Medi-Cal eligible adults, including 19,056 under expansion, or 12.0%.
- Tulare County: Total 178,153 Medi-Cal eligible adults, including 24,620 under expansion, or 13.8%.
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org. CVJC research assistant Marisol Herrera contributed to this report.