Miriam Martinez’s mouth is a testament to what it means to be poor and without dental coverage. Several front teeth are capped with metal. She’s had three molars pulled in recent years, and has cavities in many of the rest. On a recent afternoon, she’d come to the Watts Health Center in South Los Angeles to have two more molars pulled.
"I can’t really chew my food," she said, a dental bib hanging from her neck. "I don’t go to the dentist frequently because it’s so expensive."
The 52-year-old Martinez gets health coverage through Medi-Cal, California’s insurance program for low-income families and individuals. And until five years ago, Medi-Cal recipients also got dental coverage through a program called Denti-Cal.
But in 2009, faced with a gaping budget hole, the state legislature eliminated dental coverage for adults, with the exception of emergency care. Five years later, with the state budget in better shape, some of those benefits are being restored.
But dentists say the gap in coverage lasted so long that many patients’ oral health deteriorated, since they couldn’t get basic cleanings or fillings.
"We have had many, many patients come through who could possibly be treated to save their teeth," said Dr. Frazier Moore, the Watts Health Center’s dental director. "But because of the financial burden on them, they take the choice to have them removed. So this puts us in a downhill slide for these patients to become what is commonly referred to as a dental cripple."
The partially restored dental benefits kick in again on May 1st, and are expected to affect roughly 3 million Californians who’d previously lost dental coverage.
"We’re delighted that the legislature moved to restore benefits," said Dr. James Stephens, president of the California Dental Association. "There are some critical things that are not there, but this is a start."
Cleanings, fillings, root canals, and full sets of dentures are among the treatments that will again be covered. But Stephens said there are two glaring omissions.
The first is gum treatment. Stephens said diabetics who have chronically inflamed gums can have a harder time controlling their blood sugar.
The second is partial dentures, for people who’ve had just one or two teeth pulled. Stephens and other dentists have said they’re concerned that patients unable to have dentures made for individual teeth might ask to have other teeth pulled so they can achieve a complete smile with a full set of dentures.
"The more natural teeth you have, the more efficient your chewing is going to be," said Stephens. "Your diet is going to be better. You can eat more healthy, less processed foods."
Stephens said the Dental Association plans to continue urging the legislature to restore coverage for the excluded treatments.
A spokesman for State Senator Darrell Steinberg (D-L.A.), who led the effort to revive Denti-Cal, said it’s still too early in this year’s budget process to know whether he’ll push for restoration of coverage for gum treatments and partial dentures.
Patients aren't the only ones with a stake in the Denti-Cal restoration.
Dr. Irving Lebovics is the dental director at Cedars-Sinai Medical Center, where he oversees new dentists completing their residency programs. He said cuts to Denti-Cal made it difficult for programs like his to train new dentists, who gain experience by treating Denti-Cal patients. Those training programs -- at hospitals, clinics and dental schools -- have seen steep declines in patient visits, he said.
"You know, we have an up-and-coming group of young dentists, and if we can’t properly train them, it’s only going to hurt the public down the line," Lebovics said.
He said he, too, is looking forward to May 1st, when Medi-Cal recipients will regain dental coverage.
In fact, some of those Californians are already getting treatment, if they go to what's called a "federally qualified health center," a clinic that meets certain standards of care and is subject to federal oversight. In a highly technical ruling in September, the Ninth Circuit Court of Appeals found that Denti-Cal reimbursements never should have been eliminated for treatment at clinics with that federal designation.
The Watts Health Center is one of those clinics. Bill Hobson, its CEO, said full-scale treatment has already resumed. He said the court ruling for federally qualified clinics, along with the upcoming Denti-Cal restoration for all other dental clinics, will expand much needed care across the state.