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Medi-Cal Cuts Set Californians' Teeth on Edge

New America Media, News Report, Viji Sundaram Posted: Jun 01, 2009

BERKELEY, Calif. - Going to the dentist was never something she looked forward to, but last week Barbara Brown seemed eager to get into the dentists chair at Lifelong Dental.

I have to get everything done before July 1, said the 55-year-old Oakland resident as she sat in the waiting room of the clinic in a bright pink tracksuit. If dental benefits go, I will have to pay out of pocket, and thats not something I can afford.

Come July 1, around 3 million low-income Californians like Brown will see their dental benefits vanish, under legislation passed by the state earlier this year to address its budget deficit of $23.4 billion.

Other Medi-Cal programs set to go on the chopping block that day include optometry, podiatry, psychology and chiropractic care. Governor Arnold Schwarzenneger and state legislators believe the cuts of these optional services will save the impoverished state about $614 million annually.

I dont know how the governor could come up with such a plan, observed Dr. Neshat Rezai, a dentist at Lifelong. What will those people do who have no teeth? How will they eat, or how will they get a job?

Medi-Cal is Californias version of the federal Medicaid program. It provides health care to 6.6 million low-income and disabled residents.

Ive been on Medi-Cal for years, said 56-year-old Shirline Lane on a recent morning after getting some much-needed bridgework done to stop losing more of her brittle teeth.

Lane said she saw a sign outside Lifelong, warning adult Medi-Cal patients that their dental benefits would disappear in a few weeks. She quickly made an appointment.

Lifelong, where 80 percent of the patients are Medi-Cal beneficiaries, has seen an almost 40 percent spike in patient visits in the last few weeks, said Rezai. She points to a list of appointments she has that day - more than a dozen.

Her colleague, Dr. John Noble, said he has been double-booking patients and "packing them in in the last few weeks.

Our patients are the neediest, he said. They cannot afford to pay $75 for a filling.

The phones are constantly ringing at Oakland's Asian Health Services these days, with Medi-Cal patients wanting to beat the July 1 deadline. Dental operations coordinator Linh Tran said that up until last week they have been able to accommodate almost all of the callers, but have begun warning those who require extended procedures such as dentures or root canals that they may not be accepted under their Medi-Cal plan in a few days.

In fact, dentists in some community clinics have already begun turning patients away who come for extended procedures, noted Elizabeth Landsberg, a health care advocate at the Sacramento-based Western Center on Law and Poverty.

Hoping to stop the impending cuts from going into effect, the California Primary Care Association (CPCA), along with two community clinics, has filed a lawsuit against the state in April to maintain the dental services for Californias poor and disabled.

The state is required to provide those FQHC (Federally Qualified Health Center) services, asserted Elia Gallardo, CPCAs director of government affairs.

CPCA and the Dental Health Foundation (DHF) commissioned a report on the impact of eliminating many dental benefits for adults under Medi-Cal. Those benefits include diagnostic and preventive dental treatment, fillings, root canals and tooth extractions. The report, which DHF executive director Wynne Grossman said will be released June 11, found that the cuts will have ripple effects, not only on the affected individuals and their families and communities, but also on Medi-Cal and the overall health care system.

Even as it is, most uninsured people put off going to the dentist until it becomes a medical emergency. According to a recent poll released by the California Health Care Foundation, the number of people who showed up in hospital emergency rooms rose 12 percent from 2005 to 2007, from 70,000 Californians to 83,000. If the cuts go through next month, it will exacerbate the crowded conditions in emergency rooms.

If they cut Denti-Cal (the dental benefits under the Medi-Cal program), oral health is going to deteriorate, and people could end up in the hospital, said Rezai, as she prepared to re-cement a crown on one of her Medi-Cal patients.

Even though Denti-Cal will remain intact for patients under 21 even after July 1, a number of dentists are planning to take themselves out of the program because its just not worth it for them to take just children, Grossman said.

When Medi-Cals adult dental benefits disappear, so will jobs. Dental offices like Lifelong are bracing for layoffs. Most community clinics rely on Medi-Cal payments for anywhere between 40 percent and 80 percent of their funding.

We are going to drop from 12,900 visits a year to about 7, 700, noted Deanna Cervantes, Lifelong Dentals clinic director. We are probably going to cut half the staff here.

Asked what she will do if her dental work is not completed by July 1, or if she develops some new dental problems after that, Lifelong patient Lane looks worried. Then, she shrugs and says: I guess Ill just have to ignore it. Ill be like all those other people out there who are walking around with raggedy mouths.

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