Back when I toured nationally, I played a lot of comedy clubs in Texas, and my San Francisco comic buddies would tease me for playing venues that had a โtwo- tooth minimum.โ California/Texas tooth disparity is real: Californiaโs Medi-Cal, our version of Medicaid, provides comprehensive dental benefits to eligible adults through Medi-Cal Dental. Texas Medicaid generally does not provide comprehensive dental coverage for most adults.
I had not been to a dentist in years but recently my comedy career reignited; I played the Truckee KOA where a woman got so turned on by my act she threw her teeth onstage. I go to my wifeโs dentist, who x-rays my mouth for $300 and tells me that, while I donโt have any cavities, I need three crowns that will cost me out-of-pocket over $5,000. $5,000 is close to my total comedy income last year, counting the change I found in the seats after the shows.
The good news is that Californiaโs newly signed 2026โ27 budget delays a planned reduction in Medi-Cal Dental benefits until July 1, 2027. For Dientes, that one-year reprieve for certain adult immigrants preserves coverage for patients who otherwise would have lost routine dental benefits this summer, but it postpones rather than settles the political fight.
If you are low income and wonder if you qualify for Medi-Cal, donโt assume you make too much. Eligibility depends on household size, age, disability status, pregnancy and other factors, and the rules change. Californians can check their eligibility through the MyMedi-Cal portal, BenefitsCal, or by contacting their county Medi-Cal office.
Santa Cruz Countyโs hidden dental system
This story is not about my teeth; itโs about all of ours. Facing a $5,000 bill for crowns, I began exploring an exciting new retirement plan: chewing only on the left side of my mouth. The crowns, my dentist explained, were preventive. My back molars were cracked and worn from decades of nighttime teeth grinding.
They hadn’t broken yet but someday will. I got accepted into Medi-Cal Dental. The state paid to fill one small cavity I actually had but declined to pay for the three crowns. My molars, according to Medi-Calโs guidelines, werenโt broken enough. I left with an uneasy understanding that California will help me after my molars shatter, but not necessarily before.
Dignity through dentistry
Ask people in Santa Cruz County what Dientes is, many will have a vague idea. I spoke with Sheree Storm, Chief Strategy Officer for Dientes, who explained that roughly 70,000 Santa Cruz County residents receive their health coverage through Medi-Cal. Dientes expects to provide more than 80,000 dental visits this year to approximately 18,000 patients through its five clinics and a mobile dental program in Santa Cruz County.
This isnโt charity dentistry. It is a professionally staffed nonprofit health system employing about 150 people, with digital X-rays, modern operatories, pediatric dentistry, oral surgery, dentures, periodontal care. Its clinics look like the private dental offices we have been visiting for years.
โOur whole thing is dignity through dentistry,โ Storm tells me. โWe want people to walk in and feel like theyโre treated really well.โ
Storm says another misconception is who actually receives Medi-Cal. Storm sees independent contractors, gig workers, retirees, people working multiple jobs, small business owners, people trying to make ends meet in one of Californiaโs most expensive counties. Hardworking people. Even journalists.
I ask Storm how many Santa Cruz County dentists accept Medi-Cal Dental. Storm says the stateโs provider directory lists ten private Santa Cruz County dentists as accepting Medi-Cal Dental, but only five were listed as accepting new patients.
Suddenly, Dientes makes a lot of sense. The organization isnโt merely another dental clinic; itโs part of the countyโs safety net.
Storm explains that the hardest appointment to get is the first one. Getting through the front door remains the biggest hurdle and that bottleneck isnโt because dentists donโt care, it’s because dentistry is expensive. Every practice must pay for buildings, equipment, sterilization, staff, insurance, laboratory work, technology and continuing education before a single filling is placed. These costs help explain why relatively few private dentists participate extensively in Medi-Cal Dental.
Storm isn’t criticizing them. The question isn’t whether private dentists are compassionate. The question is whether the reimbursement system makes it financially possible.
We pay for catastrophe, not prevention
Years ago, I had a neighbor in Seabright who ignored his leaking roof; he thought replacing five shingles seemed too costly. Twenty-five years later, the entire house had to be torn down.
Evidence suggests that preventive dental care isn’t merely compassionate policy, it’s sound economics.
California learned that lesson the hard way after eliminating most adult Medi-Cal dental benefits in 2009. Nearly three million low-income adults lost access to routine cleanings, fillings, crowns, dentures and root canals. Instead of saving money over the long run, the state saw an immediate surge of roughly 1,800 additional dental-related emergency room visits each year, while Medicaid spending on those visits jumping 68 percent.
When California restored adult dental benefits beginning in 2014 and fully in 2018, access improved dramatically. Medi-Cal Dental providers increased by 34 percent, and new dental visits by Medi-Cal patients rose 37 percent (American Dental Association).
The price of prevention, the cost of catastrophe
Longtime Santa Cruz dentist Dr. Alan Heit has watched that cycle play out for nearly four decades. I asked the health provider why people postpone dental care.
โFear is part of it,โ Heit said. โA huge part of it is economics. Do you want to pay for a filling or pay the rent? A filling that initially costs less than $500, can become a root canal and crown costing thousands.โ
Alan tells me that emergency departments may prescribe antibiotics, control pain or admit someone with a dangerous infection, but many patients leave still needing a dentist. Hospitals, and ultimately all of us absorb part of that expense.
Heit sees something that doesnโt appear in budget spreadsheets. A painful mouth changes lives; dental infections can spread beyond the mouth into other parts of the body. Missing teeth change nutrition because people stop eating foods that are difficult to chew. Chronic pain affects judgment, parenting, work performance and simple day-to-day patience.
โOral health has to do with your overall well-being,โ Heit says. โPsychologically and physically.โ
I asked the good doctor what he would do if he ruled the world. His prescription for California is simple: routine examinations, x-rays and cleanings. Find problems early. Fix them early. โItโs a no-brainer. Prevention is primary.โ
Newsom’s budget does not permanently restore or expand Medi-Cal Dental. It simply delays the proposed reductions for one year, meaning the political fight over adult dental benefits will return during next year’s budget negotiations.
As for me, Medi-Cal says my worn-down molars aren’t broken enough to justify paying for crowns. Maybe theyโre right, Iโm still chewing. But after talking to Alan Heit and Sheree Storm, my thinking has changed. A state-of-the-art dental office I found in Sacramento has offered to give me three preventive crowns for $800 apiece. Damn, that seems expensive. But maybe the expensive thing is doing nothing. Be it climate change, or shingles on a roof, or our teeth, we always pay eventually. Do we want to pay for prevention, or catastrophe?
Donโt mess with Texas. They might gum you.
