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News & Press: Advocacy

Denti-Cal Update

Tuesday, March 8, 2016   (0 Comments)
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Denti-Cal Update
In what I reported as a positive development for under compensated providers in the previous issue of The Bulletin, the Governor and the legislature reached agreement in the fiscal 2015-2016 state budget to exempt dental services from the 10 percent across-the-board Medi-Cal payment reductions applied in 2013, beginning July 1 of this year. Implementation of the prospective rate restoration, however, is still being delayed pending approval by the Centers for Medicare and Medicaid Services (CMS). Until that federal approval is granted, payments to Denti-Cal providers will continue to reflect the 10% reduction. Once CMS approval is acquired, the state will correct underpayments to Denti-Cal providers made for services provided since July 1. It is unclear whether this will be done by issuance of a check or by application to future claims. While this should be viewed as a positive step toward rebuilding our state Medicaid Dental Program, dental reimbursement rates in California are still at the same level as they were in the year 2000. A recent state audit noted that the state’s reimbursement for the most common pediatric dental procedures are only 35 percent of the national average and that less than half (46 percent) of children enrolled in Medi-Cal received any dental service in the previous year. A little over half of all children and one-third of adults in the state are now Medi-Cal eligible, creating a dental service demand beyond the resources
and capacity of the current Denti-Cal delivery system. A recent report by the Department of Health Care Services (DHCS) reported that the number of Denti-Cal providers has decreased 15 percent since 2008, while the number of beneficiaries has increased by 5 million in the same time period.

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