California officials illegally slashed payments to dental hygienists who treat some of the state’s most fragile residents, including the elderly and people with developmental disabilities who are too frail to visit the dentist’s office, a judge has ruled.
Los Angeles Superior Court Judge Mary Strobel found last month that the state’s Department of Health Care Services failed to obtain permission from the federal government before it cut its rate for a special cleaning by 58 percent and created new preauthorization process for it and other dental procedures.
The department runs the publicly funded dental program for the poor known as Denti-Cal.
“After doing research, we realized that not only was it wrong for them to do what they did, but they didn’t seek federal approval, so they did it against the law,” said Darci Trill, a hygienist working in Alameda and Contra Costa counties. She is one of eight plaintiffs who filed a lawsuit against the department in 2016, shortly after the changes were made.
Larry Hall, the plaintiffs’ attorney, said department officials told him that they plan to appeal. The department declined to comment on the case.
The plaintiffs are among a specially trained class of dental hygienists who make house calls to patients living in nursing homes and board-and-care facilities.
These patients are particularly vulnerable to gum disease because they can’t care for their own teeth, the hygienists said.
When plaque and tartar build-up leads to inflammation and infections, hygienists perform a procedure called “scaling and root planing,” which is a deep cleaning below the gumline. After they do that, the hygienists usually follow up with special cleanings every three months to keep the gums healthy.
The state reduced the reimbursement rate for those quarterly cleanings from $130 to $55. The hygienists say that’s inadequate, but the department has said the rate is similar to what other states pay.
The department also created a new preauthorization process that requires hygienists to obtain X-rays of their patients’ mouths. Capturing those images is not always possible, however, because some patients have involuntary head movements or refuse to open their mouths widely enough, Trill said.
The number of cleanings performed by independent hygienists plummeted 45 percent, from 70,671 in the 19 months before the new policy took effect to 38,915 in the 19 months that followed, according to department estimates in court documents. “That’s a huge impact. That’s a lot of people not getting the standard of care,” attorney Hall said.
The hygienists fear the issue will remain tied up in court for months or years to come. Meanwhile, they say, patients continue to suffer as the lower rate and preauthorization process remain in place.
Trill estimates that she has lost about 70 percent of her Denti-Cal clients because most of her requests to treat them have been rejected.
The lower rate of pay also makes it harder for hygienists to continue treating these patients because it doesn’t cover their costs, she said.
Trill worries that the damage to her patients’ teeth may be irreversible. “We’re going back to a bigger mess and bigger medical emergencies,” she said. “Some may not even have teeth.”
Gita Aminloo, one of the plaintiffs, will no longer see five patients in a Rancho Cucamonga board-and-care home that she has served for seven years, because none has received approval for continued dental work.
“It breaks my heart, but I’m doing what I can,” she said.
Aminloo is looking for private-pay clients in senior living homes and memory care centers to make up for the Denti-Cal patients she has lost.
“I just hope that by the time all of this is resolved, we’re still in business,” she said.
This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.