Kids with Toothaches: Lost in the Health Care Debate

Photo by Kevork Djansezian/Getty Images. This post has been updated.

Somewhat lost in the war of words over health care reform is a stepchild of the debate: dental care. A bad situation is getting worse.

Teeth are crucial. When free health care clinics for poor people are held in California, the number one activity is extractions. The California Dental Association says the top chronic childhood disease is tooth decay. But a third of Americans say they skip dental checkups because of the cost.

Until 2009, in California, dental care was part of Medicaid, or Medi-Cal as it’s called in California. More than three million poor, disabled and elderly adults had been eligible for subsidized care of their teeth. But cash-strapped California, looking for ways to save money, eliminated dental care for adults under Medi-Cal two years ago, and pocketed $109 million. At the same time the state gave up $134 million in federal matching funds.

Children still get their tooth care paid for, if they can find a dentist who is willing to accept the low reimbursement rates the state provides, which are far less than half the normal fee the dentist usually makes. But even if they find a dentist, their parents, who have been denied free dental care themselves, are less inclined to take their kids in for exams, cleanings and fillings. And increasingly, that’s a problem. Then this year the California legislature decided to reduce reimbursement rates another 10 per cent for all Medi-Cal services, including dental care for children. Those lower fees may make it even harder to find a dentist. The state also eliminated funding for school-based programs that provide fluoride treatment and dental sealants.

(To see how Medicaid dental benefits in your state have changed in the last 10 years, check out this interactive graphic.)

The changes in Medi-Cal rates – and their effects on dental health – have received almost no attention, especially as they concern teeth. But they’ve upset some health advocates, including Health Access, an advocacy group. Anthony Wright, executive director, says the cuts “will have a real impact on Medi-Cal patients” – some 7.6 million poor and disabled Californians. Wright says there’s been a huge spike in the need for dental services. The state medical and dental associations have also expressed concern. A recent study in Los Angeles County concluded that tooth decay among poor, young children is widespread and getting worse.

But the state, defending its actions and the need for less spending, says it has studied the problem and is convinced that access will not be affected. Officials will make those studies public, monitor the effects of the reductions and make changes if they think access is impaired.

Meanwhile, when asked about what a poor person with children should do, the Dental Association advises them to look for free community clinics, or try to get care at a dental school. There aren’t very many of them, either, especially in rural areas. And some dentists – the association says – will adjust payment schedules for poor patients.

In the context of the battle over health care reform, the battle over dental care for the poor may seem small, but it’s crucial to overall health. And it’s largely unsolved.