California Reduces State Dental Medicaid Benefits and Patients Suffer

This is me working on a patient at the Simi Valley Free Clinic last year

California patients who cannot afford treatment have been suffering for some time now.

Little surprises Nagaraj Murthy, a dentist in Compton for the past 32 years.

He has seen patients who have suffered toothaches for years. Others who haven't been to the dentist in a decade. Some who can't chew hard food.

But in the two years since California sharply reduced dental benefits for roughly 3 million Medi-Cal recipients, he and other dentists say the situation has become dire for patients who are waiting until their infections land them in an emergency room or their rotted teeth have to be immediately pulled.

"They aren't coming until the mouth is completely swelled up or the pain cannot be tolerated," Murthy said.

Dental care is the oft-ignored cousin of medical care, experts say. Because dental coverage is an optional benefit under the federal Medicaid program for the nation's poor, several states don't offer it. Others, like California, have slashed the benefit in recent years, meaning millions nationwide are going without treatment and facing heightened risks of serious and costly health problems like respiratory infections and heart disease.

One-third of Americans reported skipping dental checkups and care because of the cost, according to a Kaiser Family Foundation poll released in April. And a report by the national Institute of Medicine in July said "persistent, systemic" barriers, including lack of insurance and a shortage of dentists, are increasingly limiting people's access to dental care and exacerbating socioeconomic disparities in public health. The report urged states to include dental coverage for adults with Medicaid and recommended better training so primary care doctors can spot oral diseases.

"Oral health isn't just the responsibility of dentists," said Frederick P. Rivara, a Seattle pediatrician who chaired the committee that wrote the report. "There is a real need to have other healthcare providers involved."

Pending reforms of the healthcare system aren't expected to help. Some provisions are designed to increase public education, dental training and dental care by providers such as hygienists and dental health aides. But many of the those improvements aren't funded. And despite the push to provide health coverage to the uninsured, experts say adults who cannot afford private dental plans will still be on their own.

Since California cut back dental coverage, Murthy said he has lost about half of his adult patients because they don't have money to pay for services. He doesn't charge them for preliminary exams but said he can't afford to provide free treatment.

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And, there are dentists, such as myself, who could help some of these indigent patients out, be willing to accept lower pay, if there was an appropriate situation to provide care - like a facility and infrastructure.

But, there is none and with California's budget shortfall, there will be NO help from the state anytime soon.