This is KPBS Midday Edition. I'm Maureen Cavanaugh. The government spends more than $1 billion annually on California cheap. Denti-cal offers dental insurance to millions of Americans. Most dentists refuse to participate. We examine the big holes in the dental care safety net. The information health services in Oakland is the rare office that sees patients get their dental coverage from Medi-Cal. There are six Dennis working on 50 patients a day. The clinic cannot keep up with demand. April 2017 -- we are booked through them. This woman is waiting for treatment. She has been waiting for almost 2 years. That's when the resident first made an appointment for some tooth pain. Dental assistant Anna translates the Korean. She said the appointment takes six months to get in. X-rays show a cavity. It would be another six-month wait to pellet. They told me I need a root canal. It stopped the decay but she needed a crown to cap a. While she waited for that the tooth broke. The tooth is no good anymore. It's now this -- it now needs to be extracted. They say it's a familiar story. They work for a film that helps Latino immigrants navigate health services. Just seen people on Denti-cal who have so much trouble finding care or have to wait so long they take matters into their own hands. The way until there is an emergency and get teeth pulled out. To go to Mexico or another garage or pull them out themselves. Pat Toomey are horror stories. There's no need to get to that point. There's widespread evidence that Denti-cal is open. The 2014 state audit found 11 counties have no dentist taking Denti-cal patients. When I first came out of dental school pretty much everybody had some Denti-cal patients. It was part of our civic duty. She does not accept it anymore. While California spends $1 billion on Denti-cal services they paid dentists the lowest rate in the country. The amount of paperwork and bureaucracy is so great she would rather not deal with it. For me I find it is easy to just do it for free. Another state oversight report shows of rates the state pays for it into Cal -- Denti-cal has not increased since 2001 . I would say it's doing the job at supposed to be doing. The downtick -- Denti-cal chief says there are enough dentists. She says those experiencing long waits need to call Denti-cal for help. She also agrees with the reports. They were fair and they reinforce what the program already knows about itself. They are exploring how they can streamline paperwork and better connect people with dentists. It will likely get harder because of basic math as dentists continue to drop out lawmakers have almost doubled the number of eligible patients. The problem is fundamentally about how the state prioritizes dental care. It's like we carve the mouth out of the body. We would not let a kid run around with a cut hand or broken leg but we will let them run around with a mouthful of cavities and they are in pain. Lawmakers have acknowledged the problems and have recently made efforts to gain momentum. That has not included any more money to gain rates and attracts dentists. We will take a closer look at one lawmakers are and are not doing to fix Denti-cal. Joining me now is better Bradford state reporter with public radio. Welcome to the program. The state report that you mentioned that says the Denti-cal program is broken -- what kind of response is that getting from lawmakers. We have seen more action on Denti-cal this year than we have in a number of years. Obviously that report and then there is a state audit in 2014 that came before it and both of these have been really critical reports and have spurred some action. What are we talking about? The main side it is going through this administrative go There's a bill by assembly member Jim would that tries to clear up some of the paperwork inches and is pretty amazing. Number of dentists I talked to that say they are not the rates that are so low -- I've heard the same story a lot of times that because they have six months to get the paperwork cleared. It takes a really long time to enroll if you are a dentist and you want to participate in Denti-cal severs a bill on its way to the governor that would require Denti-cal to fix some of these paperwork issues. There really hoping that that is going to make a substantial difference. That would perhaps take care of the paperwork problem but the money is still an issue. How much money but the program need to be competitive with traditional insurance? Medi-Cal and Denti-cal all pay lower rates than insurers to. Denti-cal pays about a third of what private insurers pay. It's also one of the lowest states in terms of reimbursing Medicaid dollars. Right now the program spends about $1.4 billion a year. If you were to put that up to private insurers would have to triple that. There's a couple things that they are trying to do to lower the cost but the biggest thing that lawmakers point me to because there is no more state money going toward Denti-cal this year. There is some more federal money. They have gotten essentially into a pilot program to encourage more dentists. They focused on preventative dentistry with cleaning and good brushing habits. The idea is -- the access to dental care is much more costly and then there are emergency room business. They are working on making a dent in both covering but lowering the cost. We heard some proposals being put forth by Republican lawmakers rather startling. What happened with those proposals. You don't usually see Republicans pushing for more funding for low income entitlement programs. That is exactly what happened. There's no state money to be added to raise the very low reimbursement rates this year. Republicans had a proposal that they said would add $200 million a year to the program ongoing so that's a difference from the federal money which would end in five years and it does not have the same strings attached. They said we want to put this toward raising the rates for the most common procedures and get them up to the national average for Medicaid. That proposal died and I think the sense among Democrats in the legislature is that this was kind of a political ploy and the camera to a in the process and we have -- we are already late in the budget negotiations and we can put this money in now. The Republican argument is that we have the maximum family grant anyone looking to put more money toward affordable housing and we have these state reports and let's go ahead and fix that for funding these other priorities. The dentist you spoke with said he should not separate them out from the person's health. Is that the issue that teeth are just not as important? Is that maybe an American additive? How often do you think about it? If you are hurting somewhere if you are hurting and you put a Band-Aid over it and you take care of it and clean it and you don't practice good brushing habits. The Centers for Disease Control points to tooth decay as the number one health problem for children. There's this problem where Doctor Scott did a really good job of explaining and they are in pain and have a hard time studying. It's clear that this is a problem but in general the way we separate this as a carved out things from the rest of medicine. I don't know whether it is a prioritization problem with the legislature or state officials but I think it is a systemic structure issue. I've been speaking with Ben Bradford -- from capital public radio. Inc. you. -- Thank you.
Gov. Jerry Brown's administration and California lawmakers have solutions to the state’s broken program known as Denti-Cal, but they don’t want to spend a lot of money.
The problem is that 13 million patients are eligible for Denti-Cal, but only a quarter of California’s dentists see even one of them a year.
RELATED: How A Broken, $1 Billion State Program Leaves Californians With Cavities
A stack of papers on the desk of Stockton dental surgeon Nicolas Veaco can help explain why. It's a chart from a recent, tricky surgery Veaco performed on a Denti-Cal patient.
“Because of the number of teeth that needed to be removed, and because he couldn’t go off blood thinners, we did his treatment in three separate appointments,” Veaco said.
Then Veaco billed Denti-Cal. The total fee was $4,000. Denti-Cal will pay $672. That means Veaco gets 17 percent of what he would from private insurance.
These notoriously low rates are the main reason dentists cite for not accepting Denti-Cal. The other problem is the paperwork.
"That chart looks more like a phone book than a magazine," Veaco said.
It took that much correspondence with Denti-Cal before he got paid.
“There’s a lot of work put in for those few patients for very little reimbursement," Veaco said. "I look at treating these patients almost more a charity than I do a business thing, and there’s only so much charity I can give.”
Lawmakers in Sacramento have recognized this problem, but they’re not solving it by opening the state checkbook. Democratic Assemblyman Jim Wood, a dentist himself, has authored legislation to reduce the paperwork. He spoke at a hearing in June.
“If we can cut some of the red tape, I know a lot of my colleagues would gladly take Medi-Cal patients," Wood said.
That bill has passed the state Legislature, but low pay will remain a problem even if Gov. Brown signs it, Wood acknowledged.
To address that, Democratic lawmakers and the Brown administration are looking to the federal government. It’s agreed to give Denti-Cal a temporary infusion: $750 million over the next five years, a more than 10 percent bump to the program’s budget.
“I think it’s going to be extremely helpful,” Denti-Cal Chief Alani Jackson said. “It gives us an opportunity to test how does getting additional moneys for the services you’re already rendering impact provider participation.”
But the funding comes with some limits. It would pay dentists higher rates, but only after they see a set number of patients. It would only apply to treating children. Some of the funding would be restricted to certain counties with few dentists. And it’s specifically for preventative medicine — to encourage more sealants and cleanings, and teaching good brushing habits.
“The whole theory behind it is let’s prevent the disease before it starts, so I applaud that," said Dr. John Blake, who runs the Children's Dental Health Clinic in Long Beach. "But you’re going to get to the point where you can’t prevent some of it and some of it will have to be treated.”
Blake said his clinic has already become a "dumping ground" for other offices that can only provide basic dental care; they send him patients who need costly work they can't provide.
Dentists and health advocates generally agree the federal money would help, but many worry that its temporary nature and attached strings would limit its usefulness.
Blake said if the state wants to fix Denti-Cal, it would have to find the money.
There is currently one plan to do that.
Republican leaders in both Assembly and Senate favor adding 200 million state dollars a year to Denti-Cal. They estimate the additional funding could pay dentists the national average for the most common procedures.
“Let’s not play a game that says we’re going to try to provide dental care for 13 million Californians when they can’t actually access dental care,” Republican Assembly leader Chad Mayes said. “If you’re going to have a program, let’s make sure it works.”
The bill died in the Senate.
During a budget discussion, Assemblyman Tony Thurmond said they brought it up too late and it costs too much.
“They did bring a proposal, pretty much at the end of the process, and what we’ve committed to is to having ongoing conversations about how we can do something around Denti-Cal going forward,” Thurmond said.
With a week left before the end of the session, that hasn’t happened. California will have to rely on the temporary infusion of federal money and pared down paperwork to allow Denti-Cal patients access to the care they’ve been promised.
Copyright 2016 Capital Public Radio.
