Families and care providers for special needs adults across the state rely on Denti-Cal, a subset of Medi-Cal for their dental needs.
Dentists and care providers now say as a result of Denti-Cal policies that have been enacted by the state Department of Health Care Services, or are soon to be enacted, many special needs patients' wait times for proper dental care has stretched to several months, almost a year in some cases.
It used to take Karen Farnsworth just a few weeks to schedule a doctor or dental appointment for Terry O'Donnell, who is severely autistic and blind.
"Now just to get preventative care it takes two to three months, sometimes up to six months," said Farnsworth.
One yearly visit that was entirely covered under Denti-Cal has also been changed to one visit every two years, according to Farnsworth.
Farnsworth, director of California Programs for the Autistic, said the longer waits are a direct result of new guidelines the DHCS have put in place for Denti-Cal patients.
She says patients like O'Donnell suffer sudden outbursts during medical appointments, and need to be put under.
"The sights, the sounds, the smells can be really frightening for them," said Farnsworth.
Denti-Cal's new anesthesia policies make that harder to do.
Now, O'Donnell will need to prove he meets a standard for anesthesia. Dentists need to rule out other weaker alternatives, and he'll have to be re-evaluated every year, according to dentist Rodney Bughao, who deals with special needs patients.
"It just creates more roadblocks," Bughao said.
He calls DHCS simply unrealistic.
New rules also mandate the same anesthesiologist who will see each patient must meet with them before an appointment.
"That's an almost impossible task to accomplish, the anesthesia groups for the most part, they don't even know which patients they're going to be seeing until the night before," Bughao said.
DHCS sent a written defense of its screening process for anesthesia, saying:
"DHCS' policy on general anesthesia is consistent with basic standards for pre-anesthesia care and applies to all patients who receive anesthesia care. General anesthesia can entail risks to the patient that are not present in less invasive approaches, such as local anesthetic, so it is important that less invasive measures are considered and evaluated in reaching a decision to approve general anesthesia."
These new rules, on top of pay that Bughao says won't even cover costs for hospitals and surgical centers, have led most Denti-Cal dentists to stop treating special needs adults altogether.
In May, Sutter Health cut off access to surgical space for dentists to work on special needs Dentists-Cal patients, according to Bughao, though says Sutter has since provided for certain patients on a case-by-case basis.
"Come out and observe us, just for a day, and see the struggles we go through ... we talk about policies and guidelines, we have to remember these are real people here," Bughao said.
He added those who often can't speak up for themselves are at the losing end of this situation.
Farnsworth said her office has to resort to driving two hours to see a Sacramento dentist who will provide care for her clients, because the local Denti-Cal dentists closed shop.
"It's really hard to watch. I've been doing this for 10 years. To think our guys potentially won't have any dental care at all -- it's really a big challenge," Farnsworth said.