Friday, August 16, 2013

CHILDREN’S ORAL HEALTH CARE: Not this year. Maybe next year? …but on the cheap!

Dental disease is the leading factor in school attendance and is critical to academic performance among low-income students – so lets not provide the ‘essential benefit’  next year (even to kids with insurance) …and let’s cut reimbursement when we do!

by smf for 4LAKids News

smf: August 16, 2013  ::  Over the past year I have participated with various children's oral health advocates in the discussion with the various policy makers from the feds and state; providers, insurance companies and regulators in

  • the implementation of  the Affordable Care Act/ACA (Obamacare), and
  • the demise of Healthy Families and its combination into MediCal. Both state programs serve children’s health needs.

What became obvious was:

  1. Medical care trumps Dental care (and Mental Health care) in the pantheon of healthcare special interests, and
  2. the simultaneous ACA rollout and Healthy Families/MediCal consolidation was overwhelming to all the bureaucrats+bureaucracies.

As a result children’s oral healthcare in California was thrown under the bus.

This is a prime example of  adult issues trumping the interests of children – and for all the handwringing apologies none of the parties gets any sympathy from me!

Children are entitled to this care under federal law; prevention and prophylaxis is supposed to be free under ACA. Kids are entitled to childhoods without the pain and long-term-damage of dental disease now …not a year from now!

If kids voted and owned property – if they got grumpy and wrote letters to editors and went to boring meetings of bureaucrats and regulators and insurance companies – if they got as mad as hell and shouted that they aren’t going to take it anymore - they might get the respect and care they deserve.

But they don’t and they didn’t.  They suffer with their toothaches.

So they got drilled.

California health exchange plans will include children’s dental care …in 2015

Julie Small | 89.3 KPCC

Students with dental disease face new obstacle in Medi-Cal rate cut

By Jane Meredith Adams | EdSource Today

Alameda Pediatric Dentistry

Julie Small/KPCC

August 8th, 2013, 4:00pm  ::  More than a million California children lack dental insurance coverage.

The board of Covered California declined Thursday to make changes to children’s dental coverage that will be offered to the public starting Oct. 1. Instead, the state's health insurance exchange will focus on improving coverage in 2015 — the second year of the program.

The decision came after Covered California's staff decided not to include children's dental care in medical plans that are mandated by the Affordable Care Act. Families can purchase standalone plans outside the exchange. But health advocates complained the exchange’s approach will cost consumers more than it should.

Child health care advocates packed Thursday's hearing in Sacramento to urge Covered California’s board to add health care plans that include dental care for kids in the first year of the program. Advocates argued that doing so would make many buyers eligible for federal subsidies.

State Insurance Commissioner Dave Jones submitted a letter to the board warning some parents could pay up to 400 times more for children's dental care.

At the meeting, Deputy Insurance Commissioner Janice Rocco insisted the exchange could make a last-minute solicitation to insurance companies to offer pediatric dental coverage as part of comprehensive medical plans.

“It’s more affordable, which means more families will have the coverage, which means children’s health will be improved,” Rocco said.

But Leesa Tori of the Covered California staff told the crowd: “There’s no silver bullet for 2014.”

Tori cited technical restrictions of the computer program that's been built to sell policies to the public and the reluctance of insurance providers to make a change so close to the launch of the exchange.

Several representatives from professional dental associations said children’s oral health will suffer unless parents are mandated to purchase dental insurance.

The California Society of Pediatric Dentistry reports that tooth decay is the most prevalent childhood disease. More children miss school because of dental pain than any other reason. That’s why pediatric dental care is considered an essential health benefit in the Affordable Care Act.

Dental photo
Credit: Alameda County Public Health Department

August 16th, 2013  ::  In a move that affects millions of California students who rely on Medi-Cal for dental services, reimbursement rates for dentists who care for low-income children will be cut, the Department of Health Care Services announced Thursday.

Dental disease has emerged as an important factor in depressing school attendance and academic performance among low-income students, and advocates said the reduction in reimbursement fees will make it more difficult for students to obtain care. As it stands, half of children under age 21 enrolled in Medi-Cal’s dental program did not have a single dental visit in 2011, according to a January 2013 report by The Children’s Partnership, a nonprofit group that studies children’s dental health.

Dentists who accept Medi-Cal for children’s care will have their fees reduced by 10 percent starting next month. In addition, the state will apply the fee reduction retroactively to June 1, 2011 and seek to recover overpaid funds. Current Medi-Cal dental reimbursement rates in California rank near the bottom of the nation, according to the California Society of Pediatric Dentistry, and the number of dentists who take Medi-Cal payments is limited.

“It’s most unfortunate,” said Lindsey Robinson, president of the California Dental Association and a pediatric dentist in Grass Valley. “Dental caries is the most common disease of childhood, and the bulk of the disease burden is in underserved kids,” said Robinson. “These are the kids who are going to be impacted in a big way, because access to a dentist for treatment is going to be restricted.”

Dental problems keep California students out of school for an estimated 874,000 days a year, costing schools about $29.7 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, an ongoing statewide survey by the Center for Health Policy Research at UC Los Angeles. The study is still considered the benchmark for children’s oral health. To address student needs, schools have struggled to provide a dental safety net by establishing school-based dental care.

“If kids are not healthy, they are going to miss school and if they are in pain, it’s going to affect learning,” said Hedy Chang, director of Attendance Works, a nonprofit group that studies student attendance issues.

v – continued below - v

Students with dental disease face new obstacle in Medi-Cal rate cut (column 2 above/cont) - Exempt from the 10 percent fee cut are nonprofit pediatric dental surgery centers that provide “at least 99 percent of their services under general anesthesia to children with severe dental disease.” These centers serve children who have “rampant disease” or who are too young to be effectively managed without anesthesia, said Robinson from the California Dental Association. The services are valuable, she noted, but preventive dental care is crucial.

“Otherwise, we’ll never get on top of it,” said Robinson. “In my practice, it’s very disheartening to see these kids come in with an amount of decay that is almost entirely preventable.”

By the end of 2013, about 5 million children – roughly half of the children in the state – are expected to be enrolled in Medi-Cal, according to The Children’s Partnership. The rate reduction, which applies to many Medi-Cal services in addition to dental care, was approved by the state legislature in 2011 and signed into law by Gov. Jerry Brown as a cost-cutting measure. The implementation of the rate change had been stalled in court proceedings until June.

“The State’s decision means that families will face even greater hurdles getting care for their children,” said Jenny Kattlove, director of strategic health initiatives at The Children’s Partnership, “resulting in pain and suffering among children who go without necessary care, expensive emergency room visits for preventable dental problems, and missed school and work due to dental problems.”

Efforts to reform the Medi-Cal system for children’s dental care have failed, said Ray Stewart, executive director of the California Society of Pediatric Dentistry. “The Denti-Cal system in California is broken beyond repair,” said Stewart. “I think the future is very grim and the big losers are children.”

Going deeper

Unaffordable Dental Care Is Linked to Frequent School Absences, UCLA Health Policy Research Brief, 2009

The Consequences of Untreated Dental Disease in Children, California Society of Pediatric Dentistry and California Dental Association information

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