The state of California is paying off $10.5 million in student loans for 40 dentists who agree to ensure that 30 percent of their patient caseload is made up of Medi-Cal patients – among the state’s poorest and frailest residents.
“Dentists with significant student loan debt may find it more difficult financially to commit to care for the Medi-Cal population,” said Jennifer Kent, director of the California Department of Health Care Services, the agency that administers the program. “Helping them to pay off their debt will make that commitment possible.”
Dr. Byron Ruiz, a 2018 dental school graduate who joined the Sacramento Native American Health Center, learned Wednesday that he had been selected for an award, just minutes before Gov. Gavin Newsom called him on stage to congratulate him. Ruiz said he was overcome with emotion upon learning of his good fortune.
“Gov. Newsom brought me on stage for a press conference,” Ruiz said. “I had nothing written. Whatever came out of my mouth is what I felt. It was the craziest day of my life.…For me, it was life-changing. I worked through college. I’m the only person in my family to go to college. On top of all that, I got to meet Gov. Newsom.”
Ruiz said the grant will pay off $300,000 of the $307,000 he owes for dental school at the University of California, San Francisco. In exchange, he will commit for five years to ensuring his patient mix is at least 30 percent Medi-Cal beneficiaries. He started working at the Native American health center while in dental school and was thrilled when they offered him a job, but because he owed so much in loans, he was working full time there and putting in one day a week at another dentist’s practice.
“I was thinking, in the future, I would work here part time and do private practice more full time. But now, with this loan repayment program, I see myself here for a long time. I’ll be able to commit a lot more.”
The American Dental Education Association estimates that 2018 dental school students owed $285,184 in educational loans, on average, if they graduated from a public school and $326,133 if they graduated from private schools.
Only about one-third of California’s licensed dentists take some Medi-Cal dental patients in their practice, according to DHCS statistics. Roughly 13.4 million Californians are eligible for dental care under Medi-Cal, a program known as Denti-Cal.
Denti-Cal has come under fire from the Little Hoover Commission, an independent state oversight agency. It castigated DHCS in 2016, 2017 and 2018 in reports to legislative leaders and then-Gov. Jerry Brown, saying that, among other things, the agency is ignoring the Legislature’s direction that it meet a goal of 60 percent utilization for children covered by Medi-Cal. The commission noted that half of California’s children are supposed to be getting dental care through this program.
While Ethan Rarick, the executive director of the Little Hoover Commission, remains concerned that Denti-Cal is not serving enough eligible beneficiaries, he said the CalHealthCares loan repayment program does align with a commission recommendation .
“this program clearly advances the commission’s general goal of increasing access to Denti-Cal,” Rarick said. “The most recent letter that we did in 2018 is to make access to Denti-Cal easier and more seamless, and clearly this program increases access, and that’s a good thing.”
Because payments from Medi-Cal often do not cover the cost of medical services provided, the beneficiaries often struggle to find dentists and doctors who will accept them as patients. State leaders say they expect the financial awards will provide an economic incentive for medical providers to improve access to care for low-income patients. DHCS announced earlier this month that 247 physicians would be awarded $58.6 million in student debt relief.
“Expanding access to care will ensure California’s most vulnerable residents receive oral health care, which is essential to overall health,” said Dr. Del Brunner, president of the California Dental Association, in a prepared news release. “We know student loan debt is one of the biggest financial hurdles a dentist may face and this program will allow practitioners to follow their passion of providing care for the underserved.”
Increasingly, studies have pointed out that poor dental hygiene can increase the risk of serious health problems such as poorly controlled diabetes, heart attacks, stroke and other problems. The American Academy of Pediatric Dentistry has noted that, among children from disadvantaged backgrounds, a rapid form of tooth decay has reached epidemic proportions.
The CalHealthCares loan repayment program is funded from an allocation in the revised 2019-20 budget and a $2 increase in tobacco taxes that went into effect July 1, 2017. That tax increase was part of Proposition 56, approved by California voters in November 2016.
Altogether, DHCS has $340 million to put toward the loan repayment program, and agency leaders said in a news release that they plan at least five rounds of the loan repayment program. It is run by Physicians for a Healthy California, the charitable arm of the California Medical Association. The two organizations will will start accepting applications for the next round of awards in January.
Almost 240 dentists applied for CalHealthCares. The 40 awardees – nine specialists and 31 general dentists will serve Medi-Cal patients in Sacramento County and 19 other counties in community clinics, federally qualified health centers, academic settings, group practices and private practices.
The debt relief program will cover up to $300,000 of the cost of dental school, a dental or physician residency program, and any fellowship completed within the last five years. Those who accept the awards agree to ensure that Medi-Cal patients represent 30 percent of their caseload for five years.
Janet Coffman, a professor in UCSF’s Philip R. Lee Institute for Health Policy Studies, said loan repayment programs provide recipients with a longer runway that allows many to figure out how they can make their finances work while continuing to serve the economically disadvantaged people whom they got into medicine to help. The longer anyone stays in an area, she said, they make connections, have families and put down other roots that make it tougher to leave.
Ruiz said: “I grew up in an area that was not too safe, and education was not put first. Growing up, when I would go to the dentist, I didn’t know what was going on. I didn’t what they were going to do to me. Now, I try to educate parents on what to do with their kids and educate younger people on oral health.”