Why California’s Medi-Cal Dental Care Continues to Let Kids Down

It’s been eight long years since a bold state watchdog pulled back the curtain on California’s failure to provide essential dental care to its most vulnerable children, and guess what? The situation remains dire. A recent follow-up report reveals that despite the urgent recommendations made back in 2016, progress has been disappointingly sluggish.

The Little Hoover Commission’s latest findings are alarming: fewer than half of the kids enrolled in Medi-Cal received an annual dental visit in 2022—a mere 3% increase from the dismal figures presented in 2016. “California is still doing a miserable job,” lamented Pedro Nava, chair of the commission and former state Assembly member. “We have failed generations of children. We and they deserve better.”

The original 2016 report was a gut punch to the system, exposing the unsettling truth that only 44.5% of Medi-Cal children had seen a dentist that year—an essential step in preventing painful dental decay. The commission called for an ambitious increase to 66%, and while lawmakers responded with a law aimed at achieving a 60% dental visit rate, the reality has fallen short yet again.

In the wake of a shocking L.A. Times exposé on rampant dental issues among California’s youth, the Little Hoover Commission decided it was time for a reality check. The results were grim: in 2022, only 47.6% of Medi-Cal children visited a dentist, a stark reminder that the state is missing the mark.

If this were a private company, Nava pointed out, you’d be ready to dump your stocks. “It’s disappointing that low-income families have to bear the brunt of this every single day,” he said.

While the report acknowledged some improvements since 2016, with one recommendation fully implemented and seven partially addressed, the state health department begs to differ. They claim to have fully executed all recommendations, asserting that pediatric dental visits had seen a surge to 49.6% in 2019 before the pandemic slowed progress.

“California, like every state, faced unprecedented challenges during the COVID-19 pandemic,” the Department of Health Care Services stated. They also highlighted significant changes, including expanded tele-dentistry, enhancing provider networks, and launching public outreach campaigns aimed at Medi-Cal patients.

Fast forward to 2023, and the health department insists that dental visit percentages have bounced back to 2019 levels, with projections for even greater utilization in 2024. But experts are skeptical. “They have not come close to achieving the 60% target set by the Legislature, let alone our recommended 66%,” warned Ethan Rarick, executive director of the Little Hoover Commission. “Kids’ dental health is among the worst in the country, and we have a long road ahead.”

In fact, California children suffer from some of the worst dental health in the nation. A national survey conducted between 2020 and 2021 revealed that a staggering 14.8% of children aged 1 to 17 had decayed teeth or cavities, ranking California a dismal 47th out of 51 states and the District of Columbia. “If you’re the fifth-largest economy in the world, you ought to be a leader in children’s health,” Nava exclaimed.

Across the nation, over half of children end up with cavities by the age of 8, often due to poor nutrition, inadequate dental hygiene, or a lack of access to care. The consequences of untreated dental disease are severe, leading to pain and difficulty in eating, sleeping, and concentrating in school. Low-income children of color are particularly vulnerable. Reports from Los Angeles County highlight a shocking statistic: on any given day, more than 4,500 kindergarten and third-grade children in the area require urgent dental care, indicating they may be suffering from pain or serious infections.

In an effort to turn the tide, the state has increased payment rates for evaluating children’s teeth and fillings, funded through a tobacco tax initiative and efforts to transform Medi-Cal. They’ve also streamlined the process for dentists to enroll as Medi-Cal providers and started a pilot program for tele-dentistry.

As a result, 40% of California dentists now accept Medi-Cal—a 34% increase since 2017. However, experts like Brianna Pittman-Spencer from the California Dental Association acknowledge that while improvements have been made, the road ahead is still long. “The program had such a huge hole to dig out of, and COVID really derailed everything,” she noted.

Eileen Espejo, who spearheads the oral health project at Children Now, expressed cautious optimism over the implementation of recommendations but highlighted the need for a more effective approach. “To make real progress, we have to do more than just repeat the same strategies,” she emphasized.

Her concerns extend to children in remote regions, where access to dental care is even more limited. “How do we attract providers to those areas?” she questioned, advocating for increased use of telehealth and allowing dental hygienists to offer more services as potential solutions.

“This report could ignite the conversation and rally support for more resources to enhance the program,” Espejo concluded. “The time for change is now.”

This article is part of an initiative focused on early childhood education, highlighting the importance of learning and development for California’s children from birth to age 5. For more details about this initiative and its supporters, visit latimes.com/earlyed.