If you get dental care through Medi-Cal, good luck finding a dentist in San Francisco that will treat you any time soon. The city’s clinics that still see adult patients are full, particularly in the Mission District, according to dental health care providers.

“We haven’t been taking new patients for a while because we’re at capacity,” said Lucy Wright, a case manager at Native American Health Center on Capp St., one of the few offices that serve low income adults in San Francisco. Other dentists, like those at South of Market Health Center, will still take new patients but have a months-long waiting list.

Oral health is first on the chopping block when officials need to make cuts in health care, according to dental professionals. Reimbursements from Medi-Cal for adults are already limited.

The outlook will be much worse if California follows through with its plan to eliminate dental care for poor and disabled residents next year. If it does, Medi-Cal patients will have two options: cope with oral pain or clog up emergency rooms.

“All the rest of the body is important except for the mouth,” said Samantha Stephen, dental director for the San Francisco Public Health Department.  “Every single person has teeth.”

“We’ve been making cuts for so long, there are really no programs that are not essential,” she said while trying to list government cuts to local programs and dental schools like UCSF, which she said cut its oral surgery by half. “There’s been so many I can’t remember how they all went down.”

Even in its current state under Medi-Cal, the benefits cover only the basics, providers said. For example, a patient can have a tooth extracted, but if it’s not one of the four front teeth, the gap remains—no dentures are provided because Medi-Cal won’t pay. Most Medi-Cal recipients are low-income adults under 65 who have children or a disability.

Dentists will get a small reimbursement for teeth cleaning and fillings, but they are usually unable to give crowns, teeth extractions, root canals on back teeth, or denture adjustments.

And last year, California was late in paying dentists. “We didn’t get any reimbursements for three months or so,”  said Wright from the Native American Health Center.

“We’ve already cut a lot of scope,” Avantika Nath, a dentist serving patients in three of the city’s clinics. She said her clinics have stopped sending patients teeth-cleaning reminders because they have too many requests for more urgent dental care. “We do a lot of extractions and pain management,” she said.

“We just go from triage to triage,” she said. “It is a very grim situation”

“If we have to refuse services, all those patients will end up in urgent care or in pain, or with severe abscesses,” she said.

If patients can’t afford dental care and end up using urgent care at the last possible moment, San Francisco will be footing the bill, providers said. San Francisco’s health care plan for the uninsured, Healthy San Francisco, fails to provide dental benefits.

Dental care providers don’t like to talk about what they’ll do if California decides to cut all dental care for Medi-Cal recipients, but it’s possible that to make ends meet the clinics will have to turn away their adult clients and increase their pediatric care, since poor children can still get funding.

If the state doesn’t save adult care, the real crunch will be delayed until June 30, 2010, when the reimbursements will stop.

The California budget passed earlier this year cuts all dental care from Medi-Cal. In mad math, the state has linked its part of the stimulus pie to these cuts, what it calls the “trigger.”

If the stimulus provides an extra $10 billion, then poor and disabled patients will continue to receive the current – albeit minimal – level of care. If there is one penny less than the $10 billion, the state will eliminate $130 million from Medi-Cal “optional benefits,” and dental will be lost.

The $10 billion “trigger” is tied to several kinds of government funding, including health and education.

The State Treasurer and the Department of Finance will decide whether or not to pull the trigger on or before April 1.

“You can’t imagine a worse time for this to happen,” said Stephen, the dental director for the city’s public health department. She was unable to blame anyone for why cuts were aimed at dental care and said that all types of health care are seeing reductions. “Everyone needs more money, a way lot of money.”

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Anrica is a science reporter and twice Cal grad, with a degree in engineering and a master of journalism. She's a Bay Area native and lives in Oakland. She's enjoyed wide-ranging professional endeavors, including shoveling manure, researching human signaling proteins, volunteering in a leprosy hospital, using an atomic force microscope, and modeling the electricity grid.

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  1. I am a disabled adult who suffers from heart disease and diabetes etc. etc.
    without denti-cal most of us will be in the hospital rooms or suffer with the pain!!! The brave ones will be forced to do their own dentistry by having someone tie a string around the hurting tooth and yanks away!!!And PRAY the tooth does not crack!!

  2. The government needs to stop spending money on pork projects and programs to stop the false “global warming” and start spending on it what counts – the health of Americans.