Atwater dentists among those facing Medi-Cal cuts, but state officials propose exemptions

12/08/2013 8:20 PM

12/08/2013 8:22 PM

The future looks brighter for the Central California Dental Surgicenter in Atwater and other facilities that treat low-income children who have severe tooth decay.

The California Department of Health Care Services has proposed to exempt most pediatric dental surgery centers from the 10 percent Medi-Cal reimbursement cuts approved by the Legislature more than two years ago. The exemption would be effective Dec. 1, though federal government approval is required.

In October, the surgery centers went public with concerns that the 10 percent cuts would force them to close their doors. Thousands of low-income children are referred to the centers because their dental decay is too extensive to be treated by regular dentists. The young patients are sedated so they are not traumatized as multiple procedures are performed.

The Atwater facility, Salida Surgery Center and 11 other for-profit centers statewide meet the criteria for the proposed exemption because they provide 95 percent of their Medi-Cal services to children. A nonprofit center in Sonoma County was exempt under the 2011 legislation.

“It will allow us to stay open,” said Dr. Pankaj Patel, co-owner of Salida Surgery Center on Pirrone Road, which treats 3,200 patients a year, almost all of them children.

The state’s recent decision was mixed because the centers may have to repay reimbursements back to June 2011, when the 10 percent cuts were supposed to take effect for health care providers. The owners joined in lawsuits that delayed the cuts until October but the courts ruled in favor of the state.

The co-owners of Central California Dental Surgicenter said a requirement to repay hundreds of thousands of dollars to Medi-Cal would be very difficult for the Atwater center. The facility, treating children ages 2 to 8, has operated through a partnership with Bloss Memorial Healthcare District since 1999; its 27-member staff includes dentists, doctors, nurses, assistants and office employees.

“The fees have gone down so much, we can make payroll and pay the dentists, but we’re right on the edge of going out of business,” said Larry Church, who operates the center with his wife, Michelle.

Patel said he’s faced with returning more than $1 million to the Medi-Cal program.

The surgery centers expect to receive a 60-day notice before the state implements any retroactive cuts. They could be given one or two years to repay the funds or the option of receiving reduced Medi-Cal payments until the total amount is paid.

Some of the owners met with state health officials last month and have received support from Valley legislators. Patel said he was impressed with the interest shown by Andrew McCray, chief of the Medi-Cal dental services division.

Last month, McCray paid a visit to the surgery centers in Salida and Fresno. In Salida, he observed a case in the operating room and witnessed the amount of resources and staffing involved with providing the care, Patel said.

“He seems to be interested in working with providers and increasing access to care,” Patel said.

The children who undergo restorative procedures at the centers have numerous cavities and abscessed teeth caused by preventable dental disease. Some experts believe the patient volume cries out for more dental education that targets migrant and low-income populations in the Valley.

“Early childhood caries is a big issue here,” said Dr. Michael Cadra, an oral and maxillofacial surgeon in Modesto. “I see quite a few children come to my office on an emergent basis, and we see them in the hospital emergency departments.” Cadra said the state had more robust dental education when it had an appointed dental director years ago.

Stanislaus County had a dental education program at elementary schools, which included fluoride treatments and dental sealants for students in need, but the state funding was put on hold indefinitely in 2009, said Esmeralda Gonzalez, chronic disease and injury prevention manager for the county.

Today, the county gets funding from the Children and Families Commission for dental education for kids up to 5 years old. At more than 20 family resource, Healthy Start and preschool centers, educators teach the children and their parents about proper brushing and harmful habits such as putting toddlers to bed with a bottle of milk or apple juice, Gonzalez said.

“The need is there, but the resources are not available,” she said.

According to the American Dental Association, parents should brush their young children’s teeth twice a day with a pea-sized dab of fluoride toothpaste, avoid using pacifiers dipped in sugar or honey and schedule a first visit with the dentist six months after the first tooth appears. Other tips are found at

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