As federal cuts threaten to limit Medicaid, California’s own state-funded safety net is also shrinking, including the dental coverage it has offered to undocumented residents alongside its Medi-Cal benefits.
After years of expanding who can access Medi-Cal, state regulators were set to end comprehensive dental coverage for many undocumented adults earlier this summer — a change that was delayed until July 1 of next year, after an outcry from providers and patient advocates.
In Santa Cruz County, many of those residents are patients at Dientes Community Dental, which accepts Medi-Cal and will see patients regardless of their ability to pay.
“We have grown over the years and now provide care to 18,000 people in Santa Cruz County, the majority of them are Medi-Cal beneficiaries,” said Laura Marcus, the CEO of Dientes. “and (we) are very concerned about what's coming for us with H.R. 1 and the cuts that we're anticipating next year through Medi-Cal.”
Dientes began in 1992 to provide care for underserved patients in Santa Cruz County, specifically Latinos and patients with HIV, who were being turned away from private dental clinics.
As the number of Medi-Cal enrollees grew following the rollout of the Affordable Care Act in 2014, so has Dientes — expanding from a single clinic in Watsonville to over five spanning the county, and offering specialty care like root canals and wisdom teeth removal that once required a trip outside of the region.
Medi-Cal patients who have questions about their benefits can ask their providers for information, or contact their county’s social services office:
- Monterey County Social Services Department
- Santa Cruz County Human Services Department
- San Benito County Health and Human Services Agency
Marcus said the confusion caused by the sudden changes on both state and federal levels is impacting many of the most vulnerable people in Santa Cruz County.
This interview has been edited for length and clarity.
Laura Marcus (LM): We have grown over the years and now provide care to 18,000 people in Santa Cruz County. The majority of them are Medi-Cal beneficiaries, Medi-Cal patients. We have five clinics and we have 150 staff now. And I'm very concerned about what's coming for us with H.R. 1 and the cuts that we're anticipating next year through Medi-Cal.
JO: A big part of your patient base, as you said, are Medi-Cal recipients. Can you tell me what's changing with Medi-Cal dental coverage right now?
LM: Yeah, this threat is really going to undermine these services that we've grown to provide, including specialty care. And we're the only specialty dental care provider in Santa Cruz County offering services to Medi-Cal. We used to have to send patients out of the county, including up to UCSF, to get a root canal, for example.
I don't know if you ever had a root canal. Hopefully not. Maybe you've had your wisdom teeth extracted. That is a service that wasn't available five years ago in Santa Cruz County. If we were to start cutting back on our specialty services, if we had to close clinics, those aren't something that is just like switching off a light and switching it back on. It might take a decade to get those back.
JO: So I want to untangle a couple of things because this series is about H.R. 1. The decision to cut the state benefits for dental care was made before H.R. 1 passed.
LM: Adult dental is not mandated, as you said, through the federal program. Children’s dental is. One thing we see that happens is if an adult stops coming to the dentist, it's likely that they'll stop bringing their child as well. So, you know, that may be part of the consequences.
JO: Because dental benefits are attached to Medi-Cal, broadly, these eligibility requirements that are being federally mandated by H.R. 1. — those are determining who has access to Medi-Cal. It's harder to maintain your eligibility. It's harder to qualify. There will be fewer people receiving Medi-Cal.
LM: Absolutely. And like I said and like you said, we will still be obligated to serve those patients and we will serve those patients, but it'll make it much harder for us to do that and also remain financially stable.
JO: What have you been hearing from patients as they navigate all of these changes?
LM: Well, patients are confused because of the back and forth with the state saying, “now you're benefited — now you have it, now you don't.” Some patients have, I think, because of the concerns about ICE and immigration, some patients have just stopped coming.
JO: Is there a patient that comes to mind as far as, they've benefited from this dental benefit?
LM: We see patients like this every day. We just got a call from Catholic Charities about a young woman, 15 years old, who was assaulted and has lost multiple permanent front teeth. And, you know, what do we do for a patient like this? Right? If there's not organizations like ours there to serve them, private dentists aren't just offering free care, unfortunately.
And so this benefit is so important. It's so important. It's so important to people's health, their self-esteem, their ability to function in society. And, you know, a smile has power. And, you know, everybody deserves to have one.
JO: What can people in the community do to help?
LM: Well, like I said earlier, you can take care of your own oral health and those around you, including the seniors that many of you are caring for. You can look for information about us on our website and where to get services, if you know someone that needs care. You can, of course, donate to us. You can write legislators or op-eds or your supervisor and say, “Oral health matters to me. Keep the funding coming.” And, you can vote in November.
Support for this project from Community Foundation Santa Cruz County. Bringing together people, ideas, and resources to inspire philanthropy and accomplish great things.
