By Callie Shanafelt and Heather Gilligan
California Health Report
Transportation is a big barrier to better health care in rural areas, says James Genobaga, DDS, Yuba County’s self-styled “dentist on a van.” Genobaga works on the Happy Tooth Mobile, which puts dental care on wheels to reach underserved populations.
The Mobile, an RV outfitted with all of the typical equipment of a dentist’s office, travels to five public schools in Yuba County, stopping at each site for four to six weeks. Parents give the van permission to treat their children, and kids are seen during the school day.
Children do not have to attend the school the van is visiting to get care from Genobaga – any local parent can sign their kids up for dental care.
Patients are thrilled to hop into the Happy Tooth Mobile on a recent May morning, when the RV was parked in the small town of Linda. When Ronda Bowers, outreach coordinator for the Mobile, walks into a classroom to escort a child to their dental appointment, she faces a sea of waving hands and pleas from young students. “Take me, take me,” they beg.
The lucky child with an appointment jumps to his feet and runs for the van with Bowers calling “wait for me” as he dashes through the playground.
That kind of enthusiasm may have to do with Genobaga’s entertaining bag of tricks, says Bowers. The dentist on a van is also a stand-up comedian who knows how to keep kids giggling. “Everybody likes to be made to feel special and to laugh,” Bowers says. “And they like silliness.”
Genobaga is happy to demonstrate his magic tricks, including the disappearing quarter. He’s silly with the kids, but sober when talking about the health challenges they face.
About eighty percent of the kids in the school districts they visit are on free or reduced lunch, an indication that many of their families are struggling financially.
That situation doesn’t bode well for getting children routine dental screenings and cleanings, Genobaga says.
“Maybe one of your concerns is feeding your family. That’s probably first and foremost,” Genobaga says. “Medical is probably second.” Dental care, he says, can understandably fall further down the list.
Many of the students that he sees on the van are covered by Medi-Cal. Others aren’t covered because they are undocumented immigrants. Those patients pay based on a sliding scale, often a fee of $10 a visit.
Genobaga treats all children on the van, even those with special needs such as autism, Bowers says. They only refer patients to specialists when they require oral conscious sedation for painful procedures.
The nearest pediatric dentist accepting Medi-Cal is 40 miles away from Yuba County.
Genobaga, who is not a pediatric specialist, accepts Medi-Cal in his private practice in Yuba City, Sutter County. A lot of doctors in the area don’t, he says. Yuba County has no dentists who accept Medi-Cal on their referral list.
Medi-Cal only covers emergency dental care for adults, but covers routine care for children.
Low reimbursement rates are a factor in reluctance to accept Medi-Cal, Genobaga says, as is the cumbersome bureaucratic process of getting reimbursed. “I get the frustration from other providers, because you only have a certain window to get compensated, and if you miss that window, then you are out of luck.”
Compensation from Medi-Cal, he says, is about 40 percent of his normal fee for service.
After considering starting a practice in Marysville, Genobaga set up private practice in Sutter County, and says he likes working in a rural area. Word of a good doctor, Genobaga says, spreads quickly in the area. He’s never wanted for patients.
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