SAN RAFAEL — Bobby Moske, 75, visited a community clinic a few years ago with a toothache but couldn’t find a dentist in Marin County who accepted Medicaid for a root canal.
Marin Community Clinics referred him to a dentist in San Francisco, 20 miles away. During the months it took to get authorization for the procedure, his tooth decayed further and had to be pulled.
Moske has lost six teeth in the past decade due to lack of dental care. As a behavioral health peer specialist, he wears a denture that he must remove when eating, making meals challenging. He often mashes food with his gums and avoids foods like nuts and steak. Eating with clients or colleagues can be embarrassing for him.
“I feel like I give off the impression of somebody who doesn’t take care of himself, and I do take care of myself,” Moske said.
“I try very hard. So, when I go out, I try not to smile.”
California is one of several states offering comprehensive dental benefits to adults on Medicaid. Some lawmakers aim to include more dental cleanings, exams, and implants in the program. However, many dentists don’t accept Medi-Cal, California’s Medicaid program, so new benefits don’t ensure patients can get care.
The UCLA Center for Health Policy Research found that only 21% of California dentists saw Medi-Cal patients from 2019 to 2021. Those who do often limit the number they see, resulting in only 15% of adults getting dental care in a year, said Elizabeth Mertz, a dentistry professor at the University of California-San Francisco.
“The issue is you have coverage that is useless,” Mertz said. “The state does provide coverage, but almost no dentist will accept it.”
A bill in the California Legislature aims to expand Medi-Cal coverage to include dental implants and crowns, offering more options to those with broken or missing teeth. Currently, Medi-Cal covers implants only for “exceptional medical conditions,” according to the state’s 2024 benefits guide. It’s unclear how many private dental plans cover implants, but preliminary research shows about half of individuals with a PPO plan have some coverage, said Mike Adelberg, executive director at the National Association of Dental Plans.
The bill, introduced by Democratic Sen. Aisha Wahab, would allow Medi-Cal patients to qualify for an implant if their dentist deems it the best option for a missing tooth.
“If you need an implant, you should be able to get it, especially our most vulnerable,” Wahab said. “The poorest of the poor in California deserve this.”
The Senate passed the bill unanimously in May, and it awaits a vote in the Assembly Appropriations Committee. Elana Ross, a spokesperson for Democratic Gov. Gavin Newsom, declined to comment on the bill.
According to the Centers for Disease Control and Prevention, 40% of U.S. adults have had permanent teeth pulled. The CDC reports that low-income older adults are more at risk for tooth loss, which can cause discomfort and impact eating and speaking. Prosthetic devices like bridges and dentures, or replacement teeth, can be costly, especially for those without insurance or on government programs with limited benefits.
Leah Myers, a DHCS spokesperson, said the state increased Medi-Cal reimbursements to dentists since Proposition 56 passed in 2016 and created a web-based app to enlist more dentists. As of July, more than 14,000 dentists — about 40% — were enrolled in the Medi-Cal program, according to the Dental Board’s latest numbers.
However, finding a dentist and getting needed care remains difficult for people like Moske. In most of California, 75% of Medi-Cal patients aged 21 and up didn’t have a dental appointment in 2023, according to DHCS.
When Moske testified in support of the implant bill in June, he removed his denture, showed it to lawmakers, and opened his mouth.
“I’m here to show you something,” Moske said. “Please don’t be offended. These are the teeth I lost.”
After Moske finished speaking, Assembly member Reggie Jones-Sawyer (D-Los Angeles) turned to his fellow members and removed his own denture.
“I know exactly what you went through,” he said. “I have dental insurance from the city of Los Angeles and the state of California and still had problems getting things covered. I thank you for being brave enough to let people know.”