Low-income patients are frequently denied necessary dental care for which they are entitled under the state's Medi-Cal public health insurance program, according to a new report by consumer advocates.
The document was prepared by the Health Consumer Alliance, which is a consortium of legal services groups for the poor, along with the Health Rights Hotline. The groups claim that the state has erected barriers to treatment, including:
Misinforming dentists about which services are covered under Denti-Cal, the program that provides dental services to Medi-Cal enrollees.
Denying treatments and then taking too long to consider appeals.
Failing to ensure that enough interpreters are provided for non-English-speaking patients.
Lea Brooks, a spokeswoman for the California Department of Health Services, which administers Medi-Cal, said the agency was reviewing the report but was not prepared to comment Thursday.
Lorraine Jones, director of the Health Consumer Alliance, said the report is based on complaints that its member agencies received from 466 people who had problems accessing Denti-Cal services in 2000 and 2001.
"Although this is not a scientific study of everyone who goes through the system, it is a peek into the problems that consumers have," Jones said. "Consumers don't have a very strong voice as to what happens to them in Medi-Cal and Denti-Cal."
Reza Nozarian, 35, of Glendale said Medi-Cal rejected braces for his 10-year-old daughter even though her orthodontist recommended the braces and the girl met the state's criteria.
Nozarian has filed an appeal and sought the assistance of the Health Consumer Center of Los Angeles. "We don't have money to put braces on her teeth, but she needs it," he said.
Consumer advocates have been concerned about access to Medi-Cal's dental services for years. In 1987, the Western Center on Law and Poverty filed a federal lawsuit against the state, alleging that patients did not have adequate access to dental care services. A federal court judge ruled against the state, and ordered Medi-Cal to substantially raise reimbursements to dentists for a variety of procedures. That lured many dentists back to the program.
Last week, Gov. Gray Davis proposed cutting fees to dentists and other health providers by 15% as part of a plan to bridge a massive state budget shortfall. He also proposed eliminating dental care for 2.8 million adults in the Medi-Cal program. Children and nursing home residents, however, would still be eligible to receive that care.