Access to Dental Care for Medi-Cal Recipients

Peter C Damiano; E Richard Brown; Jeffrey D Johnson; James P Scheetz

Access to dental services is important for the emergency treatment of pain and infection, the detection and diagnosis of oral diseases, the restoration of oral health, and the provision of preventive services. Regular check-ups, cleanings, sealants, and fluoride treatments can prevent the majority of oral health problems. These preventive treatments make it possible for young people today to grow up with fewer serious oral health problems. However, access to dental services may not be available for many Medi-Cal eligible children and adults. Access to dental services for the poor is particularly important in California where only 17 percent of the residents live in areas with optimally fluoridated drinking water. In 1985, the Special Committee on Medi-Cal Oversight of the California Legislature heard testimony indicating that access to dental services for Medi-Cal recipients was inadequate due to declining participation by dentists in Medi-Cal. However, the degree of dentists' participation in Medi-Cal was unknown. The four primary objectives of this study were to: Determine the accessibility of dental services for Medi-Cal recipients. Determine how Medi-Cal dental fee schedules compare with fee schedules for private dental practitioners. Evaluate the perceptions of dentists toward Medi-Cal patients and toward the Medi-Cal program. Evaluate the Medi-Cal dental referral program's ability to increase access to care. Access to Medi-Cal dental services was measured in two ways. The first method was to determine the number of dentists who would accept new Medi-Cal patients. Dentists' participation was determined when research assistants called dentists as proxy Medi-Cal patients for a check-up appointment. The second measure of access was the amount of time these proxy Medi-Cal patients had to wait for a check-up appointment compared with a patient with private dental insurance. To prevent any financial loss, appointments made by the proxy Medi-Cal patients were canceled within two working days of the time of the call. The fees paid by Medi-Cal were reviewed by comparing Medi-Cal reimbursement with fee schedules obtained from general practitioners, pediatric dentists, and a health maintenance organization (HMO). The dentists' perceptions of Medi-Cal patients and of the Medi-Cal program were determined by using telephone interviews with a systematically subsampled group of the dentists who did and did not accept new proxy Medi-Cal patients. The Medi-Cal dental referral program, which matches patients with dentists who accept new Medi-Cal patients, provides a . toll-free phone number established by the Medi-Cal program to allow patients to call and receive the name of a dentist in their area who accepts new Medi-Cal patients. Proxy Medi-Cal patients were used to determine the availability of providers in all the counties in the state, how up to date the information provided by the referral program was, and how successful the program was in placing Medi-Cal patients.

Access to Dental Care for Medi-Cal Recipients

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