Letter to Governor Brown and Legislature on Denti-Cal Update

Report #243, September 2018
Letter to Governor Brown and Legislature on Denti-Cal Update

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
October 1, 2018

For Additional Information Contact:
Jeanne R. Wolfe, Executive Director (A)
(916) 445-2125

Despite Important Investments in State's Dental Program, Access and Administration Still Could Be Improved

Since the Commission’s first review in 2016, lawmakers have poured money into California’s Medicaid dental program, Denti-Cal, in order to attract dentists and improve access to dental care for millions of low-income children and adults. Yet, data from the Department of Health Care Services (DHCS) continue to show a decrease in provider enrollment.

For parents or caregivers of children eligible for oral health care through Denti-Cal, limited access to providers can mean long waits in dental offices or lengthy commutes to find enrolled providers. At worst, delaying or forgoing treatment can lead to childhood tooth decay that results in discomfort and pain, poor self-esteem, and irregular school attendance.

Despite the attention and investment from lawmakers, the Commission found the DHCS continues to experience challenges administering the Denti-Cal program, but opportunities for improvement remain. As the next Administration sets its agenda, the Commission offers the following prospects for improved access and administration of the important program:

  1. Caregivers of Denti-Cal eligible children lack basic education about the importance of regular, preventative oral health care. Low-income caregivers and adults must be better educated about dental health and Denti-Cal;
  2. Parents and caregivers rely on help to navigate the Denti-Cal system and find dentists who will treat their child, schedule appointments, and offer other assistance as needed. Access to dental care must be expanded and made easier and more seamless;
  3. The continued disconnect between Denti-Cal providers and DHCS is a serious problem that undercuts the effectiveness of the program. Enhanced communication between DHCS and Denti-Cal providers is required;
  4. Swings in program funding, though now at a high, negatively impact Denti-Cal providers. Consistent and sustainable Denti-Cal funding is imperative; and
  5. DHCS is required to publicly report on their website data related to Denti-Cal. Yet despite improvements, more could be done. DHCS must continue to improve data access that is timely, complete, and transparent and in compliance with law.

The Little Hoover Commission is an independent state agency charged with recommending ways to improve the efficiency and effectiveness of state programs. The Commission’s recommendations are submitted to the Governor and the Legislature for their consideration and action.

Fact Sheet

Study Description

For this study update, the Little Hoover Commission reviewed progress made by the Department of Health Care Services (DHCS) in responding to recommendations offered in the Commission’s April 2016 report, Fixing Denti-Cal. After a seven month review, the Commission had found an overwhelming occurrence of preventable tooth disease, but a dearth of providers to offer treatment. The 2016 report called for drastic changes to the administration of the state’s Medi-Cal Dental program (Denti-Cal) to cut red tape to make it easier for dentists to enroll in the program and recommended state leaders set a forceful target to increase the number of children who use their benefits to visit a dentist annually.

Following an update from DHCS leaders in October 2017, the Commission pledged to continue monitoring DHCS efforts to improve the program. In March 2018, the Commission held a hearing specifically to learn what action the Department of Health Care Services had taken to improve administration of the Denti-Cal program. Commissioners also heard from family members of Denti-Cal patients and providers about challenges that limit access to dental care and opportunities to improve the administration of the program. The Commission also learned about the role of the California Department of Public Health in shaping California’s dental policy.

Agenda

Overview

In this letter, the Commission highlights the challenges and opportunities that continue to face the state’s Medi-Cal Dental program (Denti-Cal). The letter acknowledges important efforts by lawmakers to invest in improved dental care by restoring adult dental benefits and increasing provider reimbursement rates for certain dental services. It also acknowledges efforts by the Department of Health Care Services to improve access by streamlining the provider enrollment process.

During its review, the Commission heard from patients and providers that more could be done to improve this important program for low-income Californians in need of oral health care services. The Commission identified several challenges and opportunities that must be addressed by the next administration in order to deliver on California’s promise of quality dental coverage for those enrolled in Denti-Cal.


Previous Studies

Letter to Governor Brown and Legislature: Denti-Cal Program Still Broken
(Report #241, November 2017)

Fixing Denti-Cal
(Report #230, April 2016)
 

Print 
			Agenda
  • September 27
    2018
    Business Meeting
    at approximately 9:30 a.m., Room 175, 925 L Street, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, September 27, 2017
    925 L Street, Room 175
    Sacramento, CA

    I. Business Meeting Minutes from March 22, 2018 and July 26, 2018

    II. Draft Letter on Denti-Cal Update for Review, Consideration and Possible Adoption

    III. Draft Report for Review and Consideration on AI Study

    IV. Subcommittee Reports

    V. Project Selection

    VI. Implementation and Impact Activity

    VII. Reports from the California State Auditor’s Office

    VIII. Closed Session:

    PERSONNEL

    The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1). 

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE

    September 13, 2018

    For Additional Information Contact:

    Jeanne R. Wolfe, Executive Director (A)

    (916) 445-2125

    Notice of Meeting

    On Thursday, September 27, 2018, the Little Hoover Commission will conduct a business meeting to review and consider a draft report on a current study and a draft letter report on a prior study. The Commission will also conduct regularly scheduled activities. The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    Following these updates, the Commission will conduct other business as detailed on the agenda. 

    If you need reasonable accommodation due to a disability, please contact the Executive Director (A) at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 20, 2018.

  • March 22
    2018
    Follow-Up Study Concerning Denti-Cal
    9:30 a.m., State Capitol, Room 437, Sacramento, CA
    Event
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, March 22, 2018, at 9:30 a.m.
    State Capitol, Room 437
    Sacramento, CA 95814

    A Day in the Life: Patient Experiences in Obtaining Denti-Cal Services

    1. Robin Blanks-Guster, parent and grandparent of Denti-Cal patients, Sacramento County
       
    2. Laurie James, grandparent of Denti-Cal patient, Amador County (Written Testimony)

    A Day in the Life: Provider Experiences in Delivering Denti-Cal Services

    1. Dr. Nagaraja Murthy, D.D.S, Golden State Dental Group (Written Testimony)
       
    2. Dr. John Luther, D.D.S, Chief Dental Officer, Western Dental (Written Testimony)
       
    3. Dr. Elizabeth Johnson, D.D.S,  Dental Director, WellSpace Health
       
    4. Viveka Rydell-Anderson, CEO, and Dr. Mark Hagele, DDS, Dental Director, PDI Surgery Center (Written Testimony)

    A New Way Forward: Modernizing Denti-Cal

    1. Dr. Paul Glassman, D.D.S, Professor of Dental Practice, University of the Pacific, Arthur A. Dugoni School of Dentistry
      (Written Testimony)

    Administrators: Overseeing and Implementing California’s Dental Policies

    1. Jennifer Kent, Director, and Alani Jackson, Chief, Medi-Cal Dental Services Division, Department of Health Care Services
      (Written Testimony)
       
    2. Dr. Jayanth Kumar, D.D.S, State Dental Director, California Department of Public Health (Written Testimony)

    Comments Submitted by Members of the Public

    Justice in Aging

    California Dental Association

    California Dental Hygienists' Association

    Health Consumer Alliance

    Gary & Mary West Senior Dental Center

    Center for Oral Health

    Melinda Lancaster

    Children Now

    Cavity Free SF

    Donna Jackson

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    March 9, 2018

    For Additional Information Contact:
    Terri Hardy, Executive Director (A)
    (916) 445-2125

     

    Notice of Meeting

    On Thursday, March 22, 2018, the Little Hoover Commission will conduct a public hearing to examine the progress the Department of Health Care Services (DHCS) has made in addressing recommendations from the Commission’s April 2016 report, Fixing Denti-Cal. The Commission will hear from key stakeholders, including Denti-Cal patients and providers, about their experiences with the program.  The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

    At the hearing, the Commission will first hear from a panel consisting of family members of Denti-Cal patients, who will discuss the challenges of obtaining dental care and services.  Next, the Commission will hear from several Denti-Cal providers, including representatives from Golden State Dental Group, Western Dental Services, WellSpace Health and PDI Surgery Center, on the potential financial and procedural obstacles that may limit access to care. The Commission will then hear from a leading oral health policy thought leader, who will discuss the importance of ensuring stakeholder oversight and delivering preventative care for Denti-Cal patients.  Lastly, the Commission will hear from representatives of DHCS who will provide updates on implementation of the Commission’s recommendations and discuss how recent reforms are striving to improve the oral health of Medi-Cal children.  The State Dental Director will describe the California Department of Public Health’s role in shaping state dental policy.

    There will be an opportunity for public comment at the end of the hearing.  Public comments will be limited to three minutes per person.  The Commission also encourages written comments. 

    Immediately following the hearing, the Commission will hold a business meeting in the lower level conference room at 925 L Street in Sacramento.

    If you need reasonable accommodation due to a disability, please contact Commission Acting Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, March 15, 2018.

    Video

  • October 26
    2017
    Business Meeting
    9:30 a.m., 925 L Street, Room 175, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, October 26, 2017, at 9:30 a.m.
    925 L Street, Room 175
    Sacramento, CA 95814
     

    1. Business Meeting Minutes from September 28, 2017
       
    2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
    3. Closed Session
              PERSONNEL
              The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
       
    4. Subcommittee Reports
      a.  Forest Management – Status update
           – Discussion on Draft Recommendations

      b.  Voter Participation - Status update

      c.  Artificial Intelligence – Status update
       
    5. Commission Survey
       
    6. Project Selection
       
    7. Implementation and Impact Activity
       
    8. Reports from the California State Auditor’s Office
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    October 12, 2017

    For Additional Information Contact:
    Terri Hardy, Deputy Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

    At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

    Following these updates, the Commission will conduct other business as detailed on the agenda.  

    If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

    Video

Print 
		Agenda
  • September 27
    2018
    Business Meeting
    at approximately 9:30 a.m., Room 175, 925 L Street, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, September 27, 2017
    925 L Street, Room 175
    Sacramento, CA

    I. Business Meeting Minutes from March 22, 2018 and July 26, 2018

    II. Draft Letter on Denti-Cal Update for Review, Consideration and Possible Adoption

    III. Draft Report for Review and Consideration on AI Study

    IV. Subcommittee Reports

    V. Project Selection

    VI. Implementation and Impact Activity

    VII. Reports from the California State Auditor’s Office

    VIII. Closed Session:

    PERSONNEL

    The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1). 

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE

    September 13, 2018

    For Additional Information Contact:

    Jeanne R. Wolfe, Executive Director (A)

    (916) 445-2125

    Notice of Meeting

    On Thursday, September 27, 2018, the Little Hoover Commission will conduct a business meeting to review and consider a draft report on a current study and a draft letter report on a prior study. The Commission will also conduct regularly scheduled activities. The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    Following these updates, the Commission will conduct other business as detailed on the agenda. 

    If you need reasonable accommodation due to a disability, please contact the Executive Director (A) at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 20, 2018.

  • March 22
    2018
    Follow-Up Study Concerning Denti-Cal
    9:30 a.m., State Capitol, Room 437, Sacramento, CA
    Event
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, March 22, 2018, at 9:30 a.m.
    State Capitol, Room 437
    Sacramento, CA 95814

    A Day in the Life: Patient Experiences in Obtaining Denti-Cal Services

    1. Robin Blanks-Guster, parent and grandparent of Denti-Cal patients, Sacramento County
       
    2. Laurie James, grandparent of Denti-Cal patient, Amador County (Written Testimony)

    A Day in the Life: Provider Experiences in Delivering Denti-Cal Services

    1. Dr. Nagaraja Murthy, D.D.S, Golden State Dental Group (Written Testimony)
       
    2. Dr. John Luther, D.D.S, Chief Dental Officer, Western Dental (Written Testimony)
       
    3. Dr. Elizabeth Johnson, D.D.S,  Dental Director, WellSpace Health
       
    4. Viveka Rydell-Anderson, CEO, and Dr. Mark Hagele, DDS, Dental Director, PDI Surgery Center (Written Testimony)

    A New Way Forward: Modernizing Denti-Cal

    1. Dr. Paul Glassman, D.D.S, Professor of Dental Practice, University of the Pacific, Arthur A. Dugoni School of Dentistry
      (Written Testimony)

    Administrators: Overseeing and Implementing California’s Dental Policies

    1. Jennifer Kent, Director, and Alani Jackson, Chief, Medi-Cal Dental Services Division, Department of Health Care Services
      (Written Testimony)
       
    2. Dr. Jayanth Kumar, D.D.S, State Dental Director, California Department of Public Health (Written Testimony)

    Comments Submitted by Members of the Public

    Justice in Aging

    California Dental Association

    California Dental Hygienists' Association

    Health Consumer Alliance

    Gary & Mary West Senior Dental Center

    Center for Oral Health

    Melinda Lancaster

    Children Now

    Cavity Free SF

    Donna Jackson

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    March 9, 2018

    For Additional Information Contact:
    Terri Hardy, Executive Director (A)
    (916) 445-2125

     

    Notice of Meeting

    On Thursday, March 22, 2018, the Little Hoover Commission will conduct a public hearing to examine the progress the Department of Health Care Services (DHCS) has made in addressing recommendations from the Commission’s April 2016 report, Fixing Denti-Cal. The Commission will hear from key stakeholders, including Denti-Cal patients and providers, about their experiences with the program.  The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

    At the hearing, the Commission will first hear from a panel consisting of family members of Denti-Cal patients, who will discuss the challenges of obtaining dental care and services.  Next, the Commission will hear from several Denti-Cal providers, including representatives from Golden State Dental Group, Western Dental Services, WellSpace Health and PDI Surgery Center, on the potential financial and procedural obstacles that may limit access to care. The Commission will then hear from a leading oral health policy thought leader, who will discuss the importance of ensuring stakeholder oversight and delivering preventative care for Denti-Cal patients.  Lastly, the Commission will hear from representatives of DHCS who will provide updates on implementation of the Commission’s recommendations and discuss how recent reforms are striving to improve the oral health of Medi-Cal children.  The State Dental Director will describe the California Department of Public Health’s role in shaping state dental policy.

    There will be an opportunity for public comment at the end of the hearing.  Public comments will be limited to three minutes per person.  The Commission also encourages written comments. 

    Immediately following the hearing, the Commission will hold a business meeting in the lower level conference room at 925 L Street in Sacramento.

    If you need reasonable accommodation due to a disability, please contact Commission Acting Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, March 15, 2018.

    Video

  • October 26
    2017
    Business Meeting
    9:30 a.m., 925 L Street, Room 175, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, October 26, 2017, at 9:30 a.m.
    925 L Street, Room 175
    Sacramento, CA 95814
     

    1. Business Meeting Minutes from September 28, 2017
       
    2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
    3. Closed Session
              PERSONNEL
              The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
       
    4. Subcommittee Reports
      a.  Forest Management – Status update
           – Discussion on Draft Recommendations

      b.  Voter Participation - Status update

      c.  Artificial Intelligence – Status update
       
    5. Commission Survey
       
    6. Project Selection
       
    7. Implementation and Impact Activity
       
    8. Reports from the California State Auditor’s Office
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    October 12, 2017

    For Additional Information Contact:
    Terri Hardy, Deputy Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

    At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

    Following these updates, the Commission will conduct other business as detailed on the agenda.  

    If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

    Video