A 2020 Special Needs Dentistry Summit hosted by UCSF highlighted the lack of resources within California’s health care system to provide timely access to needed services for patients with special health care needs (SHCN). According to a study by the UCSF School of Dentistry, “There are millions of Californians who have developmental, mental or physical conditions that make it difficult, if not impossible, to obtain dental and medical treatment under routine circumstances. This population often lacks access to even basic oral health care because most dentists, in teaching, group or individual practice, cannot provide the specialized services these patients require.” Depending on the severity of the disability, daily health care routines can be a challenge to complete and even diagnosing dental conditions may require some level of stabilization or sedation.
The UCSF and UCLA dental schools both provide care through special needs clinics. These dental school clinics are backlogged with a minimum year-long waitlist for treatment; in many cases the waitlist is two years or more. These wait times have been exacerbated and lengthened by the COVID-19 pandemic; these patients’ oral health conditions may have escalated due to shutdowns and shelter-in-place orders. The existing surgical capacity in urban areas and at the dental schools in San Francisco and Los Angeles often means that medically vulnerable patients and their families must drive hours to access basic dental care because they need sedation services.
The expansion of settings, at either university dental schools or by creating additional capacity in the community, will significantly expand access to dental care for individuals who are unable to undergo dental procedures in traditional dental offices either due to special health care needs or the complexity of the care needed.
Development of physical infrastructure could be disbursed via a loan or grant program facilitated through DHCS contracting with an appropriate nonprofit foundation or through the CA Health Facility Financing Authority. This investment could build 10 or more clinics, depending on the size of awards.
1. The distribution of funds appropriated in this item shall be administered by the California Health Facilities Financing Authority, in consultation with the California Dental Association and other stakeholders, and shall fund the construction, expansion, modification or adaptation of dental surgical clinics or specialty dental clinics in California to increase access to oral health care for specialty populations.
2. “Specialty populations” includes patients who have disabilities that prevent them from receiving routine or specialty care due to their physical, developmental or cognitive condition.
3. The California Health Facilities Financing Authority shall award grants to eligible entities in amounts up to $5,000,000. Entities must meet criteria as established by the Authority, but at a minimum the criteria shall include:
a. A commitment to provide services to low-income patients, regardless of payer or health insurance provider, for a minimum of 10 years upon final completion of construction. This population must constitute at least one-third of the facility’s total patient caseload.
b. The facility must be enrolled and certified as a provider with the Medi-Cal program.
c. To the extent a facility does not maintain the minimum patient caseload above, the facility must repay the amount of the grant back to the Authority within five years at an interest rate established by the Authority.
d. Submission of plans to the Authority that demonstrate the proposed facility’s ability to serve patients with physical, cognitive or developmental disabilities.
4. These funds shall be expended between July 1, 2021, and June 30, 2024.