Denti-Cal Access to Dental Care for Beneficiaries With Special Needs: West Health Comments

Dear Senator Lara,

As President and CEO of the Gary and Mary West Health Institute, a San Diego-based, nonprofit applied medical research organization dedicated to enabling successful aging for seniors, I write on behalf of California’s low-income individuals living with chronic medical, mental, behavioral, or developmental disabilities who currently face greater challenges in accessing appropriate dental care than healthier people.

The West Health Institute is the organizational sponsor of Senate Bill 1464 (SB 1464), which aims to expand access to dental care benefits provided through Denti-Cal for beneficiaries with special needs. This legislation would instruct the Department of Health Care Services to provide additional funding to reimburse providers for the extra time and resources necessary to enable access to critically-needed oral healthcare for such patients. Currently, Denti-Cal’s standardized policies and payments, based on a healthier population, do not acknowledge the additional costs of caring for people with special needs and inhibit providers’ ability to receive proper payment for their care. This legislation not only aims to properly reimburse current Denti-Cal providers that treat patients with special needs, but may also incentivize more providers to accept these patients, increasing access to dental care.

Research has found that increasing dental access helps improve overall health and can result in less utilization of some services. The Kaiser Family Foundation found that improving access to dental care for low-income adults could decrease the rates of preventable emergency department (ED) visits and opioid use. Another study published in the American Journal of Preventive Medicine finds that increased access to periodontal maintenance resulted in decreased health costs for patients with Type 2 diabetes, cerebral vascular disease and cardiovascular disease.

A substantial proportion of the GMWSDC’s patients live with pain, infection and malnutrition due to dental disease, and 85 percent of these individuals are covered by Denti-Cal. Many have special needs and have not seen a dentist in years—for others it has been decades—due to the costs associated with dental care.

Appropriately caring for patients with special needs often requires additional time, multiple visits and other modifications compared to healthier patient treatments. Many cannot tolerate being in a dental chair long enough to have the necessary services provided due to their disabilities and others require additional medical screenings at every appointment before treatments can be performed. These factors contribute to additional costs, which are not currently reimbursed under Denti-Cal, limiting the amount of dental practices willing to provide oral care for these beneficiaries.

Your support of SB 1464 is critical. This legislation is the first step in the pursuit of a Denti-Cal system that ensures all patients have access to high-quality and appropriate dental care. For these reasons, the Gary and Mary West Health Institute is proud to sponsor SB 1464 (Wiener) and strongly urges your “yes” vote when it is before you in Committee.

Sincerely,
Shelley M. Lyford