For the past 90 years, the Children’s Dental Health Clinic in Long Beach has made a name for itself in a landscape where access to low-cost dental care is difficult to come by.

Serving approximately 6,500 patients a year from infants up to 21-year-olds, since the organization’s inception, it has focused on addressing the “very real social determinants of health and health inequities,” said director of advancement Karen Byrnes.

At the Children’s Dental Health Clinic, about 90% of its patients are on Medi-Cal, Byrnes said, though the clinic works with anyone, even those with private insurance or no insurance, she said.

In California, about 40% of youth are covered by Medi-Cal, California’s Medicaid program. However, only 1 in 4 dentists accept Denti-Cal, Medi-Cal’s dental care program, and those who do can only afford to accept a limited number of patients.

“There’s some really fascinating challenges with Medicaid itself as an entity,” Byrnes said.

While Medicaid as a unit has done a lot of work to reform its programs, many of the ongoing challenges associated with it stem from a lack of reimbursement for the true cost of services, said Byrnes.

“Low reimbursement rates coupled with really high administrative burdens on practices—(there’s) a lot of paperwork with processing Medicaid insurance. A lot of providers just kind of throw their hands up,” Byrnes said. “They’re like, ‘We would love to treat these kids, but we just can’t because we have businesses to run.’”

Many providers that care for patients with Medicaid often provide limited services, such as cleanings and basic preventative care, Byrnes said. That’s one way the the Children’s Dental Health Clinic differentiates itself.

“We feel this like really important to our social safety net, being a really comprehensive care provider for Medicaid patients,” Byrnes said.

One of the clinic’s areas of specialization is kids that specifically need more care—whether it’s a child or young adult with a physical, mental or developmental disability or another complex medical consideration such as cancer, many of Children’s Dental Health Clinic patients are turned away from other practices due to limitations, Byrnes said.

“There’s not a one-size-fits-all solution,” Byrnes said. “The challenge is: it takes skill, and the time that it takes to serve this community, and then just the ability and willingness of providers to serve them is low.”

Between a lack of providers and a lack of financial remuneration from public insurance, “a lot of these kids are just left without choice, without somewhere to go to access these services,” Byrnes said.

Nowadays, the need for accessible care is even greater. Anecdotally, clinicians have noticed a higher rate of cavities among patients, among other oral health needs correlated with the reduction of school-based screenings during the pandemic, Byrnes said.

From 2015 to 2019, 39% of patients at the clinic presented with conditions requiring treatments beyond standard cleaning. In the past two years, that number has risen to 56%.

With such a large caseload and demand for services, the clinic tries to limit its care to within 10 miles of its space, and to mostly Long Beach and South Bay residents, Byrnes said.

However, Health Clinic team members go to Catalina Island twice a month for outreach events, and the organization participates in a yearly event in collaboration with the California Dental Association to provide free dental care to anyone regardless of age or need.

The team at the Children’s Dental Health Clinic advocates for a more comprehensive social safety net and is committed to meeting the health care needs of underserved communities. Many of its staff members have remained at the clinic for years and decades. Photo courtesy of Karen Byrnes.

As a nonprofit, the organization operates close to break-even, but market forces have negatively affected its fragile equilibrium, Byrnes said. Because of COVID-related closures and distancing requirements, reimbursements have decreased significantly, while costs for supplies, personal protective equipment and wages to retain staff have all increased.

With an annual operating budget hovering around $4 million, Medi-Cal’s low reimbursement rates cover approximately 60% of the organization’s costs. The remaining 40% is then met through fundraising efforts, investment income and training programs, explained Byrnes.

In conjunction with USC, the organization offers a pediatric dental residency program, and through partnerships with Cerritos College and West Coast University, the clinic boasts a robust health care workforce development program, training dental assistants and dental hygienists.

“That program keeps us tethered and integrated into that kind of specialized care,” Byrnes said.

During the organization’s inception, it was more focused on mobile dentistry, but over the decades, it has become integrated with Long Beach Memorial Medical Center, Byrnes said.

Although it used to operate directly out of the hospital’s facility, it is now adjacent, renting a space on Miller Children & Women’s Hospital campus.

Despite being an independent nonprofit, the clinic’s care teams are fully integrated into a lot of different entities at the hospital, Byrnes said.

“The other interesting challenge of being a nonprofit in this space . . . we would love to be able to pay our staff more, and we just can’t,” Byrnes said. “There’s a lot of pride and ownership that helps us retain really quality people. . . . We try to stay as close as we can to market parity, but it’s a nonprofit. We wish we could do more.”

The team at the clinic is extremely close and feel committed to the organization’s mission, Byrnes said. The vast majority have worked at the clinic for years and decades, she said.

“Our team comes from the same communities that our patients are, so they know the gaps to care that patients experience and feel every day, and they see their family members struggle with access issues,” Byrnes said. “There’s just a huge pride in being able to provide stellar services to kids in their own communities, it’s such a huge driver for all of the team.”

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