Late last year, there was extensive media coverage about access to dental services for California’s Medi-Cal patients (SF Chronicle, 12/11/14). In December 2014, the California State Auditor reported that nearly 56 percent of the 5.1 million children enrolled in Medi-Cal from October 2012 through September 2013 failed to receive dental care through the program; eleven counties simply did not have dental providers willing to accept Medi-Cal patients. Marin County is an exception and, in fact, a success story, with the second highest Medi-Cal utilization rate in the state for pediatric dental care. The Marin Community Clinic, a not-for-profit Federally Qualified Health Center, is the primary provider of dental services to the county’s Medi-Cal, underserved and underinsured population. We operate three dental clinics with a total of 19 chairs and have 18 dentists, serve 11,000 patients/year (9,000 of whom are children) – and the numbers are growing. The contributions of local dentists, the creation of a Chief Dental Officer position, the formation of a Dental Advisory Committee and community philanthropy have been critical success factors.
Marin County may be one of the wealthiest counties in the U.S., but is also one of great economic, health and social disparity. The population of low-income residents continues to grow; we have large Latino population, many of whom are recent immigrants and live at poverty level.
Marin Community Clinics was founded more than 40 years ago, with a small number of volunteer physicians and nurses providing very basic primary medical care in church basements to our county’s underserved. Dental services for this population were almost non-existent. Today, like many other community clinics in Northern California, Marin Community Clinics has become a thriving clinic system. We are the largest safety net provider in the community, operating nine clinic sites (including medical, dental and teen clinics) and serving 35,000 unduplicated patients/year (13.5% of Marin’s population) , 50% of whom are children. We have 240 staff including 40 medical clinicians and 18 licensed dentists and a $30 million annual budget. (www.marinclinics.org).
Within the above context, our Dental Services Program was born. In 2008, a recently retired dentist and community health advocate, Louis Geissberger, DDS, saw the extraordinary unmet need. He approached Clinics leadership with a proposal – to ask the community to join him in raising funds to increase access to dental services, especially for children. The Clinics recruited a Chief Dental Officer (Connie Kadera, DDS) and together, in collaboration with another local pediatric dentist, John Boland, DDS, planning began. A Dental Advisory Committee was formed to help guide program development; it continues to date, reviewing policies, procedures, quality, and new programs, and makes recommendations to the Clinics’ board of directors.
Our first dental clinic opened in 2008, with six dental chairs; a second opened in 2010; eventually, the majority of the operations of the original county pediatric dental patients were transferred to Marin Community Clinics. Three years after the second dental clinic opened, demand was so high that we converted office and conference room space to accommodate additional dental chairs.
Today, the facilities and equipment are as modern as any you would find in the private sector, and are patient/children- friendly.
Our structured Dental Services program provides preventive care, fillings, minor extractions, limited root canals and dentures. When patients require more extensive work such endodontics, orthodontics and dental surgery, the Clinics’ Referral Department identifies local providers who will accept patients’ insurance.
In addition to clinical dental services, we have a strong focus on dental health education. Many of our families come to us with limited knowledge or experience in the basics of dental hygiene; consequently, our staff dedicates time to educate and train parents and children on dental care. Another plus to being part of a clinic system is the integration with our medical side and our Patient Centered Health Home approach. When children come in for their routine medical appointments, our medical clinicians talk with them about fluoride treatment and the need for dental care. When children express anxieties or fears related to dental care, we often bring in our Behavioral Health team to help. In addition, the Clinics’ OB/GYN department refers patients to a special Sunday clinic that is held just for pregnant women and at which we do not use nitrous oxide.
Even with our facility expansion, the demand for services continues. We currently serve 11,000 unduplicated dental patients each year, the majority of whom are children and on Medi-Cal. In order to respond to increasing demand and to accommodate the working schedules of our families, we have recently extended hours of operation to include evenings and weekends ;we now operate seven days a week. Both patient and staff satisfaction are high.
What does the future bring? Our ongoing challenge is “growth” – responding to ever-increasing volume through clinician recruitment, staff recruitment and facility expansion.
Our hope is that other communities will eventually experience similar success. From our patient of view, the key elements in creating a viable dental program for Medi-Cal, underserved and uninsured patients are committed dental leaders, good planning, community philanthropy, and a base of strong organizational financial health.