Calif. raises dental Medicaid reimbursement rates

2017 05 18 16 42 35 361 California Capitol2 400

After years of criticism, California is raising reimbursement rates for the state's dental Medicaid program, Denti-Cal. The 2017-2018 state budget, which was signed by Gov. Jerry Brown on June 27, allocates $140 million to increase rates for Denti-Cal providers.

The budget also raises rates for the state's general Medicaid program, Medi-Cal; provides $30 million to the state dental director's office; and will fully restore adult Denti-Cal benefits in 2018. Although Denti-Cal has offered some dental services for adults since 2014, full benefits were cut in 2009 during the height of the recession.

"The Legislature's action to invest $546 million for Medi-Cal provider payments ... is a step in the right direction," said California Dental Association (CDA) President Clelan Ehrler, DDS, in a statement to "It is our hope that the Department of Health Care Services applies the funding in meaningful ways to increase access to care for the 14 million Californians enrolled in the state's Medi-Cal program."

The fight to raise reimbursement

Denti-Cal reimbursement rates have been repeatedly criticized by organizations, reports, and stakeholders. One report found that the average payment for the 10 most frequently authorized dental procedures was $21.60, only 35% of the U.S. average, and many clinics with a high percentage of Denti-Cal patients have to rely on donations and fundraising to keep their doors open.

“The Legislature's action to invest $546 million for Medi-Cal provider payments ... is a step in the right direction.”
— California Dental Association

"The only way to make ends meet is that 50% of our revenue comes from donated sources, grants, individual donations," John Blake, DDS, dental director of the Children's Dental Health Clinic, told in 2016.

The increased rates will be paid for by revenues generated from a tobacco tax proposition (Proposition 56) that was passed last November. The proposition expanded the tobacco tax to e-cigarettes that contain nicotine and also increased the cigarette tax to $2 per pack.

Proposition 56 is expected to generate an additional $1.4 billion in revenue next fiscal year, and where that money goes has been a point of contention for state lawmakers. The expanded tobacco tax was advertised as a way to generate money for California's Medicaid programs, but an earlier draft of the budget had more revenue going to the state's general fund. CDA credits member advocacy as a turning point for the budget, which now allocates $546 million in supplemental provider payments for physician services, dental services, HIV/AIDS waiver providers, and more.

"At this writing, over 12,000 emails from CDA members and others have been directed to key decision-makers," the CDA wrote in a news article on its website. "This makes a difference in CDA's work in the Capitol and will make a difference to those who benefit from the expanded care."

While millions have been set aside specifically to pay providers for dental services, the exact amount providers will receive and the methodology behind the rates are still unknown. The Department of Health Care Services (DHCS), the organization that oversees Denti-Cal, plans to have a short description of the proposed payments on its website by late Friday.

"The Department of Health Care Services, as required, is developing the methodology for the supplemental payments," said Anthony Cava, a DHCS spokesperson. "The total amount of the supplemental payments will be known after the supplemental payment methodology is finalized."

The supplmental payments will cover services provided on or after July 1, but they are also dependant on federal approval. Providers may have to wait months before they see an increase, DHCS cautioned. However, when the supplemental payments do go out, they will be retroactive to July 1.

Stakeholder feedback

Overall, the budget has been praised as a step in the right direction to improve the oral health of Californians, and organizations seem satisfied that Proposition 56 money will raise reimbursement rates for providers.

"CDA is pleased that the Legislature's budget more closely follows the intent of the voters when they approved Proposition 56 last November," Dr. Ehrler stated. "In addition to a $30 million investment in the state's oral health program, the budget allocates $140 million for increased Denti-Cal provider rates, which will allow more dentists to participate in the program."

However, some organizations also caution that work still needs to be done. One of those organizations is West Health, a nonprofit focused on helping older adults, including by funding a dental center for low-income seniors.

"West Health commends the state Legislature for taking an initial step toward expanding access to essential healthcare services provided by community clinics, dentists, and physicians," stated Shelley Lyford, president and CEO of West Health. "While this budget represents incremental progress, California and the country are still so far behind in providing basic preventative dental services to seniors."

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