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Tooth decay still plagues California kids nearly a decade after Medi-Cal promised change

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Tooth decay still plagues California kids nearly a decade after Medi-Cal promised change

Eight years after an independent state watchdog agency harshly criticized the state for failing to provide dental care to low-income children, California has failed to remedy the problem or fully implement the commission’s recommendations, according to a follow-up review published last week.

The Little Hoover Commission found that less than half of the children in Medi-Cal received an annual dental visit in 2022 — 3% higher than when the initial report was released in 2016, which implored the state to do more to ensure that children have access to needed care.

“California is still doing a miserable job,” said Pedro Nava, chair of the commission and a former member of the state Assembly. “We have failed generations of children. We and they deserve better.”

The 2016 report was one of the most scathing reports that the commission had generated in years, Nava said. It found that only 44.5% of children in the Medi-Cal program had a visit with a dentist in 2016, a key indicator of whether children are receiving the care they need to prevent painful dental decay, and recommended that the state increase the rate to 66%. Lawmakers responded with a law requiring the health department to set a target of at least 60% of children.

Last fall, after the publication of an L.A. Times story on high rates of dental disease among California children, the commission initiated a follow-up review of the state’s progress.

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It found that the state had fallen far short of the goal; in 2022, the most recent data provided in the report, 47.6% of children with Medi-Cal visited a dentist, a 3-percentage-point increase from 2016.

“If you were an investor in a private company, and that was the best they could do, you’d sell your stock and invest it somewhere else,” Nava said. “It is a disappointment that low-income families with children have to shoulder the burden of this every day.”

Engage with our community-funded journalism as we delve into child care, transitional kindergarten, health and other issues affecting children from birth through age 5.

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California has made some improvements since 2016, the report said, fully implementing one recommendation and partially implementing seven of the commission’s eight others.

The state health department, however, disputes those findings and said they have fully implemented all of the recommendations from the 2016 report. The percentage of kids going to the dentist had been increasing significantly, they said — up to 49.6% in 2019 — but the pandemic interrupted that growth.

“California, along with every other state in the nation, was profoundly impacted by the effects of the COVID-19 pandemic. Virtually every state within the U.S. decreased and had a recovery period that lasted at least two years to return to pre-COVID figures,” the Department of Health Care Services wrote in a statement provided to The Times.

Since 2016, the department has made a number of important changes, the department wrote, including expanding the use of tele-dentistry to reach members across the state, increasing provider networks and creating a public education and outreach media campaign for Medi-Cal patients and providers.

In 2023 the percentage of children who visited the dentist “recovered to 2019 levels. Even higher utilization is projected in 2024,” the health department said, although data have not been been released on this upward trend.

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“I don’t think this response really questions the fact that they have not come close to reaching the recommendation set by the Legislature of 60% of kids getting in to see the dentist, let alone our rate of 66%,” said Ethan Rarick, executive director of the Little Hoover Commission. “Kids’ dental health is among the worst in the country, and much more needs to be done.”

California children have among the worst rates of dental disease in the nation. A national survey from 2020 to 2021 found that 14.8% of the state’s children ages 1 to 17 had decayed teeth or cavities in the last 12 months studied — ranking 47th out of 51 among all the states and the District of Columbia, with only Louisiana and Wyoming faring worse. “I don’t understand,” Nava said. “If you’re the fifth-largest economy in the world, you ought to be a leader in children’s health.”

Nationwide, more than half of children develop cavities by the age of 8, usually because of poor nutrition, bad hygiene habits or a lack of dental care.

The reality of dental disease can be devastating to children, causing pain and difficulty eating, sleeping and focusing in school, and low-income children of color are at greatest risk. L.A. County’s Smile Survey, which was conducted by the public health department, found that on any given day, more than 4,500 Los Angeles County kindergarten and third-grade children need urgent dental care, which means they may be experiencing mouth pain or a serious infection.

The state increased the payment rate for evaluating a child’s teeth, for example, from $15 to $45, and up to $100 if a dentist sees the same child two years in a row, according to the California Dental Assn. The reimbursement for a filling increased from $48 to $67.20. These rate increases were funded by Proposition 56, a 2016 tobacco tax that raised money for Medi-Cal payments, and by CalAIM, a state initiative to transform Medi-Cal. The Proposition 56 money was also used to fund county oral health plans and repay student loans for new dentists.

The state has made it easier for dentists to enroll as Medi-Cal providers by simplifying the enrollment forms and putting them online, the report said. It also began a pilot program for telehealth to help bring care to healthcare deserts through the Dental Transformation Initiative.

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Between the Medi-Cal payment rate and fewer administrative burdens, dentists appear to have taken note: 40% of all California dentists in the state now take Medi-Cal, a 34% increase since 2017, according to the dental association.

“The program had such a huge hole to dig out of, and COVID really derailed everything,” said Brianna Pittman-Spencer, senior director of government affairs at the California Dental Assn. “There have been improvements but obviously still a long way to go for the impact we want.”

Eileen Espejo, who leads the oral health project at Children Now, said she was pleased to see that the state had at least started to implement most of the recommendations, but that the numbers suggest the approach may not be working. “If we’re going to do better, it doesn’t seem like we should do more than the same,” she said.

In particular, she worries about children in far northern counties and those bordering Nevada, where dentists are hard to find. Twenty-one counties have five or fewer dental providers that take Medi-Cal, the report found. “How are we going to get providers to live in parts of the state where they aren’t yet?” she asked, adding that using more telehealth dentistry and allowing dental hygienists to provide more care could be part of the solution.

“Hopefully this report will light a fire and get more people engaged,” Espejo said. “I certainly think it opens the pathway for advocates to ask for more resources to help improve the program.”

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This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.

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FDA sets limits for lead in many baby foods as California disclosure law takes effect

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FDA sets limits for lead in many baby foods as California disclosure law takes effect

The U.S. Food and Drug Administration this week set maximum levels for lead in baby foods such as jarred fruits and vegetables, yogurts and dry cereal, part of an effort to cut young kids’ exposure to the toxic metal that causes developmental and neurological problems.

The agency issued final guidance that it estimated could reduce lead exposure from processed baby foods by about 20% to 30%. The limits are voluntary, not mandatory, for food manufacturers, but they allow the FDA to take enforcement action if foods exceed the levels.

It’s part of the FDA’s ongoing effort to “reduce dietary exposure to contaminants, including lead, in foods to as low as possible over time, while maintaining access to nutritious foods,” the agency said in a statement.

Consumer advocates, who have long sought limits on lead in children’s foods, welcomed the guidance first proposed two years ago, but said it didn’t go far enough.

“FDA’s actions today are a step forward and will help protect children,” said Thomas Galligan, a scientist with the Center for Science in the Public Interest. “However, the agency took too long to act and ignored important public input that could have strengthened these standards.”

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The new limits on lead for children younger than 2 don’t cover grain-based snacks such as puffs and teething biscuits, which some research has shown contain higher levels of lead. And they don’t limit other metals such as cadmium that have been detected in baby foods.

The FDA’s announcement comes just one week after a new California law took effect that requires baby food makers selling products in California to provide a QR code on their packaging to take consumers to monthly test results for the presence in their product of four heavy metals: lead, mercury, arsenic and cadmium.

The change, required under a law passed by the California Legislature in 2023, will affect consumers nationwide. Because companies are unlikely to create separate packaging for the California market, QR codes are likely to appear on products sold across the country, and consumers everywhere will be able to view the heavy metal concentrations.

Although companies are required to start printing new packaging and publishing test results of products manufactured beginning in January, it may take time for the products to hit grocery shelves.

The law was inspired by a 2021 congressional investigation that found dangerously high levels of heavy metals in packaged foods marketed for babies and toddlers. Baby foods and their ingredients had up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to five times the mercury level that the U.S. allows to be present in bottled or drinking water, the investigation found.

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There’s no safe level of lead exposure for children, according to the U.S. Centers for Disease Control and Prevention. The metal causes “well-documented health effects,” including brain and nervous system damage and slowed growth and development. However, lead occurs naturally in some foods and comes from pollutants in air, water and soil, which can make it impossible to eliminate entirely.

The FDA guidance sets a lead limit of 10 parts per billion for fruits, most vegetables, grain and meat mixtures, yogurts, custards and puddings and single-ingredient meats. It sets a limit of 20 parts per billion for single-ingredient root vegetables and for dry infant cereals. The guidance covers packaged processed foods sold in jars, pouches, tubs or boxes.

Jaclyn Bowen, executive director of the Clean Label Project, an organization that certifies baby foods as having low levels of toxic substances, said consumers can use the new FDA guidance in tandem with the new California law: The FDA, she said, has provided parents a “hard and fast number” to consider a benchmark when looking at the new monthly test results.

But Brian Ronholm, director of food policy for Consumer Reports, called the FDA limits “virtually meaningless because they’re based more on industry feasibility and not on what would best protect public health.” A product with a lead level of 10 parts per billion is “still too high for baby food. What we’ve heard from a lot of these manufacturers is they are testing well below that number.”

The new FDA guidance comes more than a year after lead-tainted pouches of apple cinnamon puree sickened more than 560 children in the U.S. between October 2023 and April 2024, according to the CDC.

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The levels of lead detected in those products were more than 2,000 times higher than the FDA’s maximum. Officials stressed that the agency doesn’t need guidance to take action on foods that violate the law.

Aleccia writes for the Associated Press. Gold reports for The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.

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NASA punts Mars Sample Return decision to the next administration

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NASA punts Mars Sample Return decision to the next administration

Anyone hoping for a clear path forward this year for NASA’s imperiled Mars Sample Return mission will have to wait a little longer.

The agency has settled on two potential strategies for the first effort to bring rock and soil from another planet back to Earth for study, NASA Administrator Bill Nelson said Tuesday: It can either leverage existing technology into a simpler, cheaper craft or turn to a commercial partner for a new design.

But the final decision on the mission’s structure — or whether it should proceed at all — “is going to be a function of the new administration,” Nelson said. President-elect Donald Trump will take office Jan. 20.

“I don’t think we want the only [Mars] sample return coming back on a Chinese spacecraft,” Nelson said, referencing a rival mission that Beijing has in the works. “I think that the [Trump] administration will certainly conclude that they want to proceed. So what we wanted to do was to give them the best possible options so that they can go from there.”

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The call also contained words of encouragement for NASA’s Jet Propulsion Laboratory in La Cañada Flintridge, which leads the embattled mission’s engineering efforts.

“To put it really bluntly, JPL is our Mars center in NASA science,” said Nicky Fox, associate administrator of the Science Mission Directorate. “They are the people who landed us on Mars, together with our industry partners. So they will be moving forward, regardless of which path, with a key role in the Mars Sample Return.”

In April, after an independent review found “near zero probability” of Mars Sample Return making its proposed 2028 launch date, NASA put out a request for alternative proposals to all of its centers and the private sector. JPL was forced to compete for what had been its own project.

The independent review board determined that the original design would probably cost up to $11 billion and not return samples to Earth until at least 2040.

“That was just simply unacceptable,” said Nelson, who paused the mission in late 2023 to review its chances of success.

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Ensuing cuts to the mission’s budget forced a series of layoffs at JPL, which let go of 855 employees and 100 on-site contractors in 2024.

The NASA-led option that Nelson suggested Tuesday includes several elements from the JPL proposal, according to a person who reviewed the documents. This leaner, simpler alternative will cost between $6.6 billion and $7.7 billion, and will return the samples by 2039, he said. A commercial alternative would probably cost $5.8 billion to $7.1 billion.

Nelson, a former Democratic U.S. senator from Florida, will step down as head of the space agency when Trump takes office. Trump has nominated as his successor Jared Isaacman, a tech billionaire who performed the first private space walk, who must be confirmed by the Senate.

NASA has not had any conversations with Trump’s transition team about Mars Sample Return, Nelson said. How the new administration will prioritize the project is not yet clear.

“It’s very uncertain how the new administration will go forward,” said Casey Dreier, chief of space policy for the Planetary Society, a Pasadena nonprofit that promotes space research. “Cancellation is obviously still on the table. … It’s hard to game this out.”

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Planetary scientists have identified Mars Sample Return as their field’s highest priority in the last three decadal surveys, reports that the National Academies of Sciences, Engineering, and Medicine prepare every 10 years in order to advise NASA.

Successfully completing the mission is “key for the nation’s leadership in space science,” said Bethany L. Ehlmann, a planetary scientist at Caltech in Pasadena. “I hope the incoming administrator moves forward decisively to select a plan and execute. There are extraordinary engineers at JPL and NASA industry partners eager and able to get to work to make it happen.”

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Panama Canal’s Expansion Opened Routes for Fish to Relocate

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Panama Canal’s Expansion Opened Routes for Fish to Relocate

Night fell as the two scientists got to work, unfurling long nets off the end of their boat. The jungle struck up its evening symphony: the sweet chittering of insects, the distant bellowing of monkeys, the occasional screech of a kite. Crocodiles lounged in the shallows, their eyes glinting when headlamps were shined their way.

Across the water, cargo ships made dark shapes as they slid between the seas.

The Panama Canal has for more than a century connected far-flung peoples and economies, making it an essential artery for global trade — and, in recent weeks, a target of President-elect Donald J. Trump’s expansionist designs.

But of late the canal has been linking something else, too: the immense ecosystems of the Atlantic and the Pacific.

The two oceans have been separated for some three million years, ever since the isthmus of Panama rose out of the water and split them. The canal cut a path through the continent, yet for decades only a handful of marine fish species managed to migrate through the waterway and the freshwater reservoir, Lake Gatún, that feeds its locks.

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Then, in 2016, Panama expanded the canal to allow supersize ships, and all that started to change.

In less than a decade, fish from both oceans — snooks, jacks, snappers and more — have almost entirely displaced the freshwater species that were in the canal system before, scientists with the Smithsonian Tropical Research Institute in Panama have found. Fishermen around Lake Gatún who rely on those species, chiefly peacock bass and tilapia, say their catches are growing scarce.

Researchers now worry that more fish could start making their way through from one ocean to the other. And no potential invader causes more concern than the venomous, candy-striped lionfish. They are known to inhabit Panama’s Caribbean coast, but not the eastern Pacific. If they made it there through the canal, they could ravage the defenseless local fish, just as they’ve done in the Gulf of Mexico and the Caribbean.

Already, marine species are more than occasional visitors in Lake Gatún, said Phillip Sanchez, a fisheries ecologist with the Smithsonian. They’re “becoming the dominant community,” he said. They’re “pushing everything else out.”

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