Cash-strapped California is aggressively moving its poorest residents to managed health care, whether they're seniors, rural residents or people with disabilities.

So, when Gov. Jerry Brown proposed earlier this year to transfer the nearly 900,000 poor children in the Healthy Families insurance program into Medi-Cal, he saw it as another opportunity to reduce costs by expanding dental managed care.

But something happened between then and now, and that something was Sacramento County.

Sacramento County's poorly performing Medi-Cal dental managed care program foiled Brown's plans, legislators say.

"That failure certainly has stopped the expansion of dental managed care," said Assemblyman Richard Pan, a Sacramento Democrat who also is a pediatrician. "Hopefully, we as a state have learned from that failure, and not only on the dental side. Hopefully, we can apply those lessons on the medical side."

Sacramento and Los Angeles are the only two counties with Medi-Cal dental managed care.

Their lackluster performance getting poor children to dentists made legislative leaders balk at adding Healthy Families kids to Medi-Cal dental managed care.

Instead, Senate President Pro Tem Darrell Steinberg of Sacramento and Assembly Speaker John A. Prez of Los Angeles negotiated a deal to move Healthy Families kids into the more flexible and potentially more expensive fee-for-service dental care model under Medi-Cal.

"We want to ensure that the challenges in certain counties are addressed before we contemplate a major expansion" of Medi-Cal dental managed care, said John Vigna, a Prez spokesman.

Medi-Cal, the state's version of Medicaid, is a public health insurance program for the lowest-income Californians. Healthy Families covers children in families with incomes too high to qualify for Medi-Cal, up to 250 percent of the federal poverty level.

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State heeds county woes