RANCHO CUCAMONGA, Calif. -- Devon Rising shakes his head and tries to cover his face with his hands. It's time to get his few remaining teeth cleaned, and he fusses for a bit.
Gita Aminloo, his dental hygienist, tries to calm him by singing "Itsy Bitsy Spider," the classic children's song.
Rising, 42, is mentally disabled and blind. He has cerebral palsy and suffers from seizures. It's hard for him to get to a dentist's office, so Aminloo brought her dental picks, brushes and other tools to him at the residential care facility he shares with several other people who have developmental disabilities.
Rising is among a vulnerable class of patients who are poor and so frail they can't leave the nursing home or, in his case, the board-and-care home to visit dentists. Instead, they rely on specially trained dental hygienists like Aminloo, who come to them.
But this may be the last time Aminloo cleans Rising's teeth. And it's not because of his resistance.
Hygienists say some of their patients are no longer getting the critical dental care they need because of recent policy changes: The state dramatically slashed payment to providers and created a preauthorization process they call cumbersome.
In 2016, Denti-Cal, the publicly funded dental program for the poor, cut the rate for a common cleaning procedure for these fragile patients from $130 to $55. Hygienists say they can't afford to continue treating many of them for that kind of money. They also claim that half of their requests to perform the cleanings are rejected -- an assertion not supported by state data.
The Department of Health Care Services, which runs Denti-Cal, said it made the changes to bring the program's reimbursement policy in line with other states and to reduce "unnecessary dental treatment."
But Aminloo insists the new state regulations victimize the most vulnerable people, who she said are losing their access to routine dental care.
"If these patients don't get preventive oral care, their overall health is going to suffer," she warned.