Children’s oral health is a primary part of their overall health and well-being, requiring timely access to basic preventive dental services and treatment when problems occur.
Tooth decay is the most common chronic illness among school-age children,4 times more common than childhood asthma. While the American Academy of Pediatric Dentistry recommends that children have a dental visit by the time their 1st tooth appears and no later than their 1st birthday, 37% of 2- and 3-year-olds in California have never been to the dentist. These rates are even lower for California’s poorest young children, as only 1 in 3 children, ages birth-to-3, enrolled in Denti-Cal (the dental component of the state’s Medicaid program) have seen a dentist.
By kindergarten, over 50% of children in California have already experienced dental decay and 28% have untreated decay. California students miss an estimated 874,000 days of school each year due to dental problems, costing schools over $29 million each year. Children who reported having recent tooth pain were 4 times more likely to have a low grade point average.
Figure: ER visits for dental problems
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Approximately 3.6 million children are enrolled in Denti-Cal with nearly half of all California children expected to be enrolled by 2014. There is currently a shortage of providers, with only 1 in 4 California dentists providing services to Denti-Cal beneficiaries. Most of these dentists see a low volume of children on Denti-Cal. Dentists often cite low reimbursement rates as the reason for not accepting Denti-Cal patients. In addition, 22 California counties have no pediatric dentists who accept Denti-Cal.
California should strengthen current and create new programs promoting children’s timely access to dental care and improving their oral health, including investing in state infrastructure and improving data collection. The state must also increase Medi-Cal dentist reimbursement rates and provide incentives for pediatricians to explain the importance of routine dental care to parents to increase their utilization of cost-effective, preventive dental services for children. Additionally, the state should expand the use of tele-dentistry (the delivery of dental-related services and information via telecommunications technologies) to reach under served child populations, especially in rural areas, and expand the oral health care workforce so more children can access needed services.
The 2013-14 state budget includes a 10% reimbursement rate reduction to most Medi-Cal providers. The only pediatric service affected by the cut is dentistry, despite the fact that California already ranks among the lowest nationally in reimbursing dental providers in Medicaid.16 In 2013, during the state-mandated transition of children from Healthy Families to Medi-Cal, the Department of Health Care Services worked to recruit more dental providers to accept Medi-Cal payments in order to ensure that children have access to oral health care. However, the Medi-Cal payment rate cuts will likely reduce the number of providers available and harm children’s access to care.
In response to the federal Centers for Medicare and Medicaid Services’ call to action to improve children’s oral health, the California Department of Health Care Services is creating a statewide pediatric oral health action plan to increase the numbers of children (ages 1-20) who receive preventive dental services and children (ages 6-9) who receive a dental sealant. These strategies will help increase dental utilization for children enrolled in Medi-Cal.