BILL ANALYSIS Ó
AB 648
Page 1
ASSEMBLY THIRD READING
AB
648 (Low)
As Introduced February 24, 2015
2/3 vote
-------------------------------------------------------------------
|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
| | |Santiago, | |
| | |Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
AB 648
Page 2
| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
-------------------------------------------------------------------
SUMMARY: Appropriates $4 million to the Department of Public
Health (DPH) to establish the Virtual Dental Home (VDH) program.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)$4 million General Fund (GF) to DPH to establish the program.
DPH would scale the effort, including number of sites,
individuals trained, and individuals served, to the available
funding. Supporters, who are familiar with the VDH model,
project the funding could be used to support training and
equipment in 20 communities over a three-year grant period.
2)To the extent this model is successful in promoting access to
preventive and diagnostic dental services and more children are
able to receive such services through its widespread adoption,
there could be commensurate cost pressure on Medi-Cal dental
services to reimburse for additional services (GF/federal
funds). However, any increased costs would likely be offset to
some extent by reductions in emergency dental procedures or
complications from untreated dental disease. The magnitude and
likelihood of such costs or savings is unknown.
AB 648
Page 3
COMMENTS: According to the author, good dental health is critical
to a child's ability to grow up healthy. Yet, tooth decay is the
most common chronic disease and unmet health care need of children
in California. According to the Journal of the California Dental
Association, California's oral health disparities are more severe
than the national average, particularly among low-income and
disabled populations. One-quarter of children in California have
never seen a dentist and approximately 65% of elementary school
children are in need of dental care.
The author also state that California has identified 341 Dental
Health Professional Shortage Areas (DHPSA), areas so designated
because the dentist-to-population ratio is below the threshold set
by the federal government. By their very nature, DHPSAs identify
areas throughout the state where patients frequently experience
barriers to comprehensive dental care. The author concludes that
this bill supports the expansion of an innovative and
cost-effective model for providing dental care to the residents of
this state who are in greatest need by establishing the VDH grant
program.
1)Virtual Dental Home. According to an article published in July
2012 in the Journal of the California Dental Association, "The
Virtual Dental Home: Bringing Oral Health to Vulnerable and
Underserved Populations," the traditional office and
clinic-based oral health delivery system is failing to reach a
large and increasing segment of the population. From 2009 to
2011, the number of Medi-Cal beneficiaries who received any
dental service declined by 8%. A decrease was expected for
adults since most adult dental benefits were eliminated in 2009,
however there was also a decrease for children. Approximately
6.3 million children, or two-thirds of all children in the
state, have not had any dental care by the time they reach the
third grade, resulting in missed school time. Approximately 7%
of California children missed school due to a dental problem in
AB 648
Page 4
2007, excluding time for cleaning or routine check-up.
2)State Auditor's Report. On December 11, 2014, the California
State Auditor issued a report titled "California Department of
Health Care Services: Weaknesses in Its Medi-Cal Dental Program
Limit Children's Access to Dental Care." The report stated that
insufficient number of dental providers willing to participate
in Medi-Cal, low reimbursement rates and a failure to adequately
monitor the program, led to limited access to care and low
utilization rates for Medi-Cal beneficiaries across the state.
The Audit found that 16 counties either have no active providers
or do not have providers willing to accept new Medi-Cal
patients, and 16 other counties have an insufficient number of
providers. Recent changes in federal and state laws that have
expanded Medi-Cal coverage could increase the number of children
and adults who can receive additional covered dental services
from 2.7 million to as many as 6.4 million, bringing into
question the State's ability to provide timely and adequate care
to beneficiaries.
The sponsors of the bill, the California Dental Association (CDA),
state that VDH has the potential to become a sustainable and
scalable model for dental care delivery, but needs an upfront
investment in training, equipment, technical assistance, and other
support to develop the critical mass needed to spread statewide
and truly be integrated into California's dental deliver system.
CDA notes that tooth decay is the number one chronic disease among
children; it accounts for persistent pain, trouble eating and
sleeping, missed school days, and expensive emergency room visits
for preventable dental problems. The sponsor argues that
children, low-income families and other vulnerable populations
experience disproportionate levels of dental disease in large part
due to difficulties accessing early preventive and routine dental
care.
The Children's Partnership states in support that VDH uses
AB 648
Page 5
technology to connect allied dental team members, located at
community sites - such as schools and Head Start sites - with
dentists in offices or clinics, to facilitate the provision of
comprehensive dental care for children and adults who face
barriers to accessing that care in traditional dental offices.
This bill has no known opposition.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0000660