In 2012, Gov. Jerry Brown proposed and the Legislature approved the transition of all 875,000 of the children currently enrolled in the Healthy Families Program to the Medi-Cal program, which includes coverage for medical, vision, as well as their dental care.
Nearly five years after the state eliminated dental benefits for adult beneficiaries in the Medi-Cal program, many of those benefits are being restored as of May 1, 2014. This comes largely as a result of the pent up need for dental care, so visibly demonstrated at CDA Cares.
Denti-Cal providers received positive news Jan. 9 regarding CDA efforts to stop the state from implementing retroactive reimbursement cuts, which were not included in Gov. Brown’s proposed 2014-15 budget. CDA advocated strongly against the 10 percent “clawback” of payments made since June 2011, citing the devastating impact on the provider network and patients’ ability to access care.
Denti-Cal providers received positive news regarding retroactive reimbursement cuts in Gov. Brown’s proposed 2014-15 budget released Jan. 9. The spending plan does not include a 10 percent “clawback” of payments made since June 2011 when the state authorized Medi-Cal reimbursement cuts as part of its budget.
The Department of Health Care Services (DHCS) is implementing cuts for Denti-Cal providers that were originally authorized through the state budget process in 2011. Initially, it was thought that the 10 percent rate cut applied to all services provided on and after Sept. 5, 2013. However, recent clarification by the state explained that it is implementing the cuts on all payment checks cut on Sept. 5 and ongoing, even if the services were provided in previous months.
CDA and a coalition of health care organizations aiming to stop Medi-Cal rate cuts implemented by the state filed a petition with the Supreme Court on Friday. The Petition for Writ of Certiorari asks the Court to reverse the decision by the Ninth Circuit Court of Appeals upholding the rate cuts.
California is reaching the final phases of its transition of the Healthy Families Program (HFP) to the Medi-Cal program. Since Jan. 1, 2013, the children getting health and dental coverage through the HFP have been moving to receive their care through the Medi-Cal program. Approximately 850,000 of the 880,000 children have been transitioned to date. Sept. 1 marked the transition of approximately 8,000 children who live in mostly rural California counties.
After a series of court decisions upholding the legality of the state’s 10 percent reduction to Medi-Cal provider reimbursement rates, the Department of Health Care Services (DHCS) has announced that it will begin implementing the cuts for Denti-Cal providers on Sept. 5. The Department’s announcement states that the prospective rate reduction will be phased in by provider type, beginning with dental and medical transportation and ending with pharmacies, physicians and distinct-part nursing facilities on Jan. 9, 2014.
The California Medi-Cal Dental Program (Denti-Cal) is informing dentists across the state that it is OK to provide dental services to children on Medi-Cal, including foster children, if they come to their office without a BIC (Medi-Cal) card. In a notice recently sent out in the Denti-Cal Bulletin newsletter, the state's Department of Health Care Services clarifies that in accordance with the California Medi-Cal Dental Program Provider Handbook, no identification verification is required in certain circumstances.
In a four-part series, CDA is profiling members who have taken different approaches to how they practice in order to counter changes in the profession such as an overall drop in adults seeking dental care, the decline in the economy and real estate market, increased regulatory compliance, reduced reimbursement rates and more. The second article in the series features two dentists who practice in San Francisco. In 2008, both dentists decided to end their participation as a contracted provider with dental plans. Five years have passed and both continue to operate on one fee schedule.
The California Dental Association applauds the governor’s signature of a new state budget plan that includes the restoration of Adult Denti-Cal services.
In a four-part series, CDA is profiling members who have taken different approaches to how they practice in order to counter changes in the profession such as an overall drop in adults seeking dental care, the decline in the economy and real estate market, increased regulatory compliance, reduced reimbursement rates and more. The first article in the series features a dentist who practices in Stockton with a diverse population, including low-income patients. During the last five to 10 years, she has made several changes in her practice to become more efficient.
The effort to restore Adult Denti-Cal benefits is one step closer to reality after the Legislature voted on a new state budget plan. The funding, which is a result of the leadership exhibited by Senate President Pro Tem Darrell Steinberg (D-Sacramento), still needs the governor’s signature. Steinberg made the restoration of Adult Denti-Cal a top priority after his visit last August to CDA Cares in Sacramento.
Two significant but conflicting developments in the longstanding effort to rebuild the oral health care safety net in California have occurred. In a disappointing move, on the same day that the state Senate Budget and Fiscal Review Committee endorsed restoring Medi-Cal adult dental benefits, the U.S. 9th Circuit Court of Appeals on May 24 denied a petition filed by CDA and a coalition of health care organizations aiming to stop the state from implementing a 10 percent reduction in Medi-Cal provider reimbursement rates.
In a positive sign for the millions of Californians in need of access to care, the Senate Budget Subcommittee on Health and Human Services on May 2 discussed the issue of restoring Medi-Cal adult dental benefits. Although no final recommendation was made by the subcommittee, the hearing raised the profile of this issue that has been led by Senate President Pro Tem Darrell Steinberg (D-Sacramento), who has been a vocal champion for bringing back adult dental services since his visit to the CDA Cares free dental clinic held in Sacramento last year.
As part of an effort to simplify providers’ participation in the state’s Medi-Cal Dental Benefits Program (Denti-Cal), CDA, with the cooperation of the State Department of Health Care Services’ Dental Services Department, has developed a guide to working within the program. The guide, entitled “Denti-Cal Provider Guide,” is divided into two main sections: Processing a Denti-Cal Patient Through the Dental Practice; and the Denti-Cal Billing Process.
In the wake of an adverse court ruling last fall, CDA and other stakeholders are pursuing legal and legislative avenues to prevent implementation of a 10 percent reduction in Medi-Cal fee-for-service reimbursement rates, a reduction which if fully implemented would be retroactive to June 2011. The fee reduction was part of a larger state budget deficit reduction agreement, and affected nearly all Medi-Cal providers.
The next wave of the Healthy Families Program transition to the Medi-Cal program is set to occur on April 1. It is important to note that the federal Centers for Medicare and Medicaid Services is requiring the state to again seek approval before they initiate this next phase (Phase 1c). There will be seven counties involved in the transition.
If the state gets the approval, Phase 1b of the Healthy Families Program transition will begin on March 1.
The state of California is currently in the process of transitioning the first phase of children enrolled in the Healthy Families Program (HFP) to the Medi-Cal program. The state was required to get approval from the federal Centers for Medicare and Medicaid Services (CMS), which they received on Dec. 31, 2012, in order to transition the children before Jan. 1.
Acknowledging that California’s economy is improving but still uncertain, Gov. Jerry Brown on Jan. 10 released a 2013-14 budget proposal that calls for expanding Medi-Cal eligibility as part of national health care reform, but makes no move to address calls from legislative leaders to restore optional benefits, such as adult dental, that were cut in prior years in response to fiscal crises.
California is continuing to move forward with the transition of 875,000 children currently enrolled in the Healthy Families Program (HFP) to the Medi-Cal program, which is expected to begin on Jan. 1. For many months, advocates were pushing for the delay of the transition, but recently, many of those advocates have sensed the inevitability of the transition. The focus of many organizations has turned to ensuring the transition goes smoothly for families and on monitoring access to care as the transition occurs.
Earlier this year, Gov. Jerry Brown proposed and the Legislature approved the transition of all 875,000 of the children currently enrolled in the Healthy Families Program to the Medi-Cal program, which includes coverage for medical, vision, as well as their dental care. CDA has prepared this information for members about the transition.
Top Stories: CDA wins Medi-Cal rate court case; Dental team ‘on board’ for CDA Cares; Guide for New Dentist available on Compass website
Top Stories: CDA sues over Medi-Cal rate cuts; CDA member benefits grow to meet needs; Compass offers tips for marketing dental practices in 2012