A federal judge has rejected as "grossly inadequate" California's plan to give the poor better access to dental care under the Medi-Cal health insurance program, and on Tuesday he ordered state health officials to dramatically raise the fees paid to dentists.
State officials said they will comply and implement the fee hike by Feb. 1, as U.S. District Judge John Moulds instructed. But a spokeswoman for the California Department of Health Services said the additional cost--about $177 million--might require cutting other Medi-Cal services.
"Everyone knows the state of the budget now . . . we don't have any wiggle room," said Betsy Hite.
Low compensation is the main reason Medi-Cal patients cannot find dentists willing to treat them, Moulds wrote in his order filed Tuesday in Sacramento. He said the state's proposal to increase Medi-Cal fees to 55% of dentists' average charges was not even enough to cover their overhead costs, and he ordered the percentage boosted to 80%.
Medi-Cal is considered among the more generous of Medicaid programs nationwide for the range of services it covers, even if fee levels have slipped so low that patients have a hard time finding doctors to treat them.
The Little Hoover Commission, in a scathing 1990 report on Medi-Cal, said the program was riddled with inefficiencies and reimbursement problems that discouraged doctors from participating, and thus deprived Medi-Cal recipients of care.
Only about 30% of the 4.5 million Californians covered by Medi-Cal, for example, receive yearly dental care. This compares with 57% of the state population as a whole, and 67% of those with private dental insurance.
That disparity prompted public interest lawyers to file the class-action lawsuit in November, 1987. The lawsuit claimed Medi-Cal's low dental fees and other deficiencies violated federal law, which requires such programs to provide beneficiaries with timely care and services comparable to those available to people with private insurance.
U.S. District Judge Lawrence K. Karlton ruled in the plaintiffs' favor in 1990. State officials were directed to bring Medi-Cal's dental program into compliance.
In October, a settlement appeared to have been reached to make regular dental care available, but the state's planned fee hike was inadequate for that, said Robert Newman, a lawyer for the Western Center on Law and Poverty, which represented the plaintiffs.