commentary C D A J O U R N A L , V O L 5 0 , Nº 7
Reshaping the Medi-Cal Dental Program — Evolving Oral Health Care in California Jennifer Kent, MPA AUTHOR Jennifer Kent, MPA, has more than 15 years of extensive health administration and policy experience in California that spans over three gubernatorial administrations and encompasses both private and public delivery systems. As director of the Department of Health Care Services, Ms. Kent oversaw the second largest public health care system in the nation with an annual budget of over $100 billion and serving approximately 13 million Californians. She also has experience in the private sector as a lobbyist, consultant and association executive. Conflict of Interest Disclosure: None reported.
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alifornia’s Medicaid program, Medi-Cal, is the largest in the nation with over 14 million low-income Californians currently enrolled as of June 2021.1 For perspective, the next largest Medicaid program is the state of New York, with 7.2 million beneficiaries as of September 2021.2 With such a large population and complicated program, enacting meaningful, direct and notable change is often difficult. When I became director of the Department of Health Care Services (DHCS) in February 2015, I often said that running the Medi-Cal program was like steering a cargo ship: The program was slow and built to travel long distances and carry a heavy load — it was not a speedboat. Given the vulnerable populations served by MediCal, it is also a management challenge to spend dedicated, focused time on a single element of the program when it spans eligibility, fiscal, information technology, legal and policy areas. There is often not a lot of flexibility or luxury to choose the area of the department that a director wants to work on. Rather, a single issue or public headline can dominate a department for weeks, if not months. Advocates, providers, counties, policymakers, federal agencies and state oversight agencies also have significant input into the priorities of the department, which creates a distinctly unique set of balancing these oftenoppositional demands. It was hard to
satisfy anyone, much less everyone. As a new director, one of the very first issues to catch my attention was the Medi-Cal Dental Program. But then again, it was not hard to miss! I walked into a department that had already received one extremely critical external report, with another one pending, on the failure of the program to provide basic dental care to millions of low-income Californians, especially children. Between the California state auditor’s December 2014 report “California Department of Health Care Services: Weaknesses in its Medi-Cal Dental Program Limit Children’s Access to Dental Care” and the Little Hoover Commission’s April 2016 report “Fixing Denti-Cal,” the department was under a lot of pressure to make quick improvements in a program that had been largely ignored for years. Those problems included an unacceptable utilization of preventive services, diminishing provider participation rates, lagging reimbursement rates and general staff apathy. An example in the auditor’s report noted that a federal Centers for Medicare & Medicaid Services (CMS) report had indicated that California’s utilization rate of 43.9% was the 12th worst among states in fiscal year 2013. And one of the most telling data points was our own DHCS data: 11 counties had no providers willing to accept new Medi-Cal patients and 16 counties had provider-to-patient ratios above 1:2,000. We also knew that there was at least one county without a single JULY 2 0 2 2
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