SAN RAFAEL, Calif. — When Bobby Moske went to a community clinic with a toothache a few years ago, he couldn't find a dentist in Marin County who would take Medicaid for a root canal.
Marin Community Clinics The 75-year-old man went to a dentist about 20 miles outside of San Francisco, but his tooth rotted while he waited months to get approval for the procedure. He eventually had the tooth extracted.
It was the sixth time in a decade that Moske had lost a tooth due to lack of dental care, he said. The behavioral health specialist wears dentures that must be removed to eat, making eating a chore. He often has difficulty squeezing food between his gums and limits his diet to what he can easily chew. For example, nuts and steak are off the menu. Sitting down at a table with clients or co-workers can be awkward.
“I feel like I come across as someone who doesn't take care of themselves, and I do take care of myself,” Mosquet said. “I try really hard. So when I go out, I try not to smile.”
California is among a growing number of states that provide comprehensive dental services for adults enrolled in Medicaid, and some lawmakers want to add more dental cleanings, exams and implants to the safety net program. But many dentists don't accept Medi-Cal, the state's Medicaid program, so the new benefits offer no guarantee that patients will be able to get help.
The UCLA Center for Health Policy Research found that 21% of California dentists Dentists saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often, these dentists limit the number of Medi-Cal patients they can see, resulting in only 15% of adults getting dental care in any given year, says Elizabeth Mertz, a professor of dentistry and medical sociologist at the University of California, San Francisco.
“The problem is you have useless coverage,” Mertz said. “The government provides coverage, but almost no dentist will accept it.”
One of the accounts are moving The California Legislature will expand Medi-Cal coverage to dental implants (artificial tooth roots placed in the jawbone that support false teeth) and crowns, giving patients with broken or missing teeth more options.
Currently, Medi-Cal only covers implants for “documented exceptional medical conditions,” according to state benefits in 2024 It's unclear how many private dental plans cover implants, but preliminary research has found that about half of people enrolled in PPO plans nationwide have some type of coverage, said Mike Adelberg, executive director of the National Association of Dental Plans.
Under a bill introduced by Democratic Sen. Aisha Wahab, Medi-Cal patients would be eligible for implants if their dentist determines it is the best option to replace a missing tooth.
“If you want an implant, you should be able to get it, especially our most vulnerable,” Wahab said. “The poorest of the poor in California deserve it.”
The Senate unanimously passed the bill in May, and a vote is expected in the Assembly Appropriations Committee. Elana Ross, a spokeswoman for Democratic Gov. Gavin Newsom, declined to comment on the bill.
Four in 10 American adults have had permanent teeth removed at some point, according to the study. analysis by the Centers for Disease Control and Prevention. The CDC also reports that low-income seniors are at higher risk of tooth loss, which can cause discomfort and affect eating and speech. Dentures, such as bridges and dentures, or tooth replacements may be a solution, but they can be expensive, especially for those who are uninsured or who participate in government programs with limited benefits.
While alternative options may be better for some patients, implants are the “standard of care,” says Sohail Saguezchi, director of the oral and maxillofacial surgery residency program at the University of California, San Francisco.
“They can't eat everything they want and they often find it harder to eat foods like vegetables and fruits,” he said.
The Department of Health Care Services, which oversees Medi-Cal, estimates that installing about 1.5 million implants would cost between $4 billion and $7 billion a year. Wahab worries that price tag could be problematic, since Newsom signed a state budget in June that would close an estimated 1.5 million implants. $46.8 billion deficit.
The cost of an implant varies widely. DHCS estimates it will reimburse dentists between $3,000 and $4,500 for each implant procedure. FAIR Health, a national nonprofit that estimates health care costs, reported that the average cost of a typical implant in California ranged from $4,000 to $4,800 between October 2022 and September 2023. Location matters, too. In San Francisco, for example, an implant costs about $8,000, Saguezchi said.
“Reimbursement rates must cover the costs of providing services,” said Alicia Malaby, a spokeswoman for the California Dental Association. “As with any Medi-Cal benefit, coverage is meaningless unless the state is willing to invest in it to ensure that people have meaningful access to the care they need.”
The California Dental Association, which does not support the current bill, has expressed concerns about the invasiveness of implant surgery, which requires regular follow-up visits. sponsorship of legislation require Medi-Cal to cover a standard two dental cleanings and exams per year for people 21 and older, rather than one.
DHCS spokeswoman Leah Myers said the state has increased Medi-Cal Reimbursements dentists since Proposition 56 passed in 2016 and created a web application to recruit more dentists. As of July, more than 14,000 dentists — about 40 percent — were enrolled in Medi-Cal, according to the latest data released by the Board of Dentistry.
But for people like Moske, finding a dentist and getting the care they need can feel impossible. In most states, California, 3 out of 4 Medi-Cal patients 21 and older did not have a dental appointment in 2023, according to DHCS.
When Moske testified in support of the dental implant bill in June, he pulled out his dentures, showed them to lawmakers and opened his mouth.
“I'm here to show you something,” Mosque said. “Please don't be offended. These are the teeth I lost.”
After Moske finished speaking, Assemblymember Reggie Jones-Sawyer (D-Los Angeles) turned to his colleagues and removed his dentures.
“I know exactly what you’ve been through,” he said. “I have dental insurance from the city of Los Angeles and the state of California, and I still had trouble getting coverage. I thank you for being brave enough to tell people.”
This article was prepared by Health News KFFwhich publishes California Healthlineeditorially independent service California Health Care Foundation.