Medi-Cal Dental Program improvements aim to recruit, retain providers

DHCS Director Jennifer Kent explains what recent changes mean for dentists

The state’s substantial improvements to the Medi-Cal Dental Program are giving more low-income Californians access to oral health care. Through the program, more than 13 million individuals are eligible for dental benefits. Additionally, a streamlined application and significant rate increases are prompting more dentists to join the program as providers. The changes follow years of action to improve the program, including CDA’s ongoing efforts to educate the public and policymakers about the importance of good oral health care. Jennifer Kent, director of the California Department of Health Care Services, spoke with CDA to discuss the program’s recent changes and what dentists can expect as providers.

What should dentists know about the biggest changes to the Medi-Cal Dental Program?

When I started in February 2015, some of the major improvements to the Medi-Cal Dental Program were already underway. I believe the first of many investments and positive steps the program has taken began with the restoration of the 10 percent provider rate reduction for Medi-Cal dental providers. The next year, we had the Dental Transformation Initiative put into place with the renegotiation of our 1115 Medicaid waiver in efforts to increase the participation of providers. More changes that are notable include the Proposition 56 supplemental payments that have been included in the last two cycles of budget rounds, as well as the restoration of dental benefits for adults.

Tell us about your department’s efforts to recruit and retain dental providers.

There have been significant initiatives as well as administrative efforts on our part to recruit and retain dental providers. This includes the simplification of the application and an outreach campaign that we have done for both beneficiaries and providers. The ongoing efforts through the Delta Administrative Service Organization contract have also been a key factor in our recruitment and retention efforts. For a while, we had mobile dental vans in counties where we did not have any Medi-Cal dental providers. Additionally, we would dispatch people to work with dental providers in their offices to help with billing and enrolling issues. The friendlier and more available we are in our technical assistance certainly helps providers want to stay in the program.

Around the DTI itself, there are many incentives to support dental practices with big safety-net populations. There are incentives for seeing more Medi-Cal dental beneficiaries, conducting caries risk assessments, participating in the local dental pilot projects or for just seeing patients over multiple years and creating that continuity of care. I believe these initiatives are making providers feel that we are doing our part to help embed patients in their practice — not only from a financial incentive standpoint, but also to create a stronger patient-provider relationship.

Enrollment can be confusing. How can dentists make sense of becoming a Medi-Cal dental provider?

By fall of 2019, dental providers will be added to the Provider Application and Validation for Enrollment (PAVE) web-based software, which simplifies and adds efficiencies to the enrollment process. Until then, providers can access the streamlined paper application on the Medi-Cal dental website. In addition to PAVE, the department recently implemented a new provider self-service web application that is also available through the Medi-Cal dental website. It allows providers to access their eligibility, payment, claims and historical treatment information 24 hours/7 days a week.

Our enrollment contractor offers one-on-one enrollment assistance in person or via the provider assistance line 800.423.0507.

How can gains from Proposition 56 supplemental rates be made sustainable and stable for providers?

Proposition 56 revenues are significant and have done a lot to support both physicians and dentists in the Medi-Cal program to the extent that Prop. 56 revenues, supplemental payments and rates remain stable. We have worked closely with CDA and others to construct the payment approach so that we are less likely to be in a position where we will have to reduce or take away supplemental payments.

The department has allocated $30 million toward a student loan repayment program for dentists who commit to serving Medi-Cal dental beneficiaries. Why is this important for dentists?

Due to the significant amount of debt that dentists accumulate while in school, providers do not have as much flexibility to decide their patient caseload or where to practice, and we have the desire to change that. We are trying to remove some of the negative consequences of people choosing to practice with a high Medi-Cal caseload, which may not help them meet their student debt. We believe the loan repayment program will have an extraordinary impact on providers not only starting in the Medi-Cal program, but for providers staying in the program long-term because of the significant nature we are willing to dedicate toward their loans.

Can you discuss the department’s idea of relocation grants for dentists to work in underserved areas?

As a component of the $30 million loan repayment, we offer providers a grant to relocate to an area where there are fewer than five providers enrolled in the Medi-Cal dental program. The general concept for the practice location is for dentists who meet certain requirements, including a longer-term commitment, to help support their establishment of an office in an area of high need where there are little to no dental service providers. We believe that where we locate dentists has the potential to change the access to oral health care for an entire community.

For more details about the student loan repayment program, see below. For more on Medi-Cal Dental Program outreach efforts, read “Smile, California: Helping Medi-Cal members use their dental benefit” published recently on CDA’s website and in the December Update.

Related Items

Preliminary criteria for the Prop. 56 Dental Loan Repayment Program were recently announced by the California Department of Health Care Services. The program will repay up to $300,000 toward student loans for dentists who commit to serving Denti-Cal beneficiaries. Applications will open this spring with participants selected no later than July 1.

Smile, California: Helping Medi-Cal members use their dental benefit
Outreach efforts also focus on recruiting, retaining providers
A campaign to increase Medicaid-enrolled members’ use of Medi-Cal’s dental benefit was launched recently by the California Department of Health Care Services as part of an integrated plan to improve the overall performance of the state’s dental program. The “Smile, California” campaign will educate eligible members about the free and low-cost services available to maintain good oral health and make it easier for members to access care. Outreach efforts also focus on recruiting and maintaining providers.

New state revenue from the taxation of tobacco products, along with support from legislators and Gov. Jerry Brown, is putting over half a billion dollars toward increased Medi-Cal dental provider reimbursements for 2018-19. The higher reimbursement follows years of activity to improve the Medi-Cal dental program and increase access to oral health care for California’s 13.5 million Medi-Cal members.