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CDA Major Issues & Priorities

1. Dental Insurance Accountability & Transparency

An estimated 86% of Californians have some form of dental insurance coverage. Nationally, of those with dental coverage, nearly 50% have employer-sponsored coverage; 21% have coverage through Medicaid or other public programs; and 5% purchase a dental plan on their own.

The enactment of the Affordable Care Act (ACA) in 2010 resulted in comprehensive reform of medical insurance plans, which led to increased transparency and patient protections. However, dental insurance plans were exempt from many of the ACA’s provisions. Dental plans are also exempt from other federal and state rules that medical plans must follow. CDA is addressing this through two sponsored bills this year:

AB 1048 – Patient Protections & Rate Review (CDA-Sponsored): This legislation by Asm. Buffy Wicks (D-Oakland) will establish stronger patient protections and transparency in dental insurance plans by:

    • Prohibiting dental plans from implementing arbitrary waiting periods or denying claims related to a patient’s pre-existing dental conditions. 
    • Requiring dental insurance premium rates to be reviewed by state regulators to ensure value for patients and employers. 

Dental plans are able to impose waiting periods, often ranging from three months to one year, before patients can access certain benefits (even though they are paying premiums). These arbitrary waiting periods limit the ability for a patient to access needed care, usually major services like a root canal or a crown. Dental plans can also deny coverage for pre-existing dental conditions like a missing tooth or genetic conditions like a cleft palate.

Furthermore, dental insurance is currently exempted from the state’s mandated review process for insurance premium rates. This review process applies to many other types of insurance including medical, automobile and pet insurance. Meanwhile, recent reports of health care spending show that out-of-pocket expenses for dental services grew by 16% in 2021, and a California Health Care Foundation survey found that 38% of Californians have a family member who skipped dental care last year due to cost. And yet, the typical annual coverage maximum for a dental plan has been $1,500-$2,000 since the 1970s (a $2,000 annual maximum in 1970 would be equivalent to $15,745 in 2023 dollars). AB 1048 would require greater oversight of dental insurance to help ensure patients are receiving better value. Authorizing rate review of dental insurance premiums would allow the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) to help protect consumers from unreasonable or unjustified increases.

AB 952 – ERISA Notification (CDA-Sponsored): This legislation by Assembly Member Jim Wood, DDS (D-Santa Rosa) will increase transparency of dental insurance by requiring appropriate notification to patients and dentists of whether a dental plan is state or federally regulated. 

Dental insurance is generally regulated by state law, with the exception of “self-insured” employer plans, which are regulated at the federal level through the Employee Retirement Income Security Act of 1974 (ERISA). In a state regulated dental plan, an employer pays a premium to an insurance carrier, and the carrier pays the cost of health care claims for anyone in the plan (employees and their dependents). Alternatively, in a federally regulated “self-funded” plan, an employer pays fees to an insurance carrier for certain administrative services, but the employer bears the cost of any employees’ health care claims. Despite the numerous California laws and regulations protecting patients and setting standards for medical and dental insurance, dental plans that are federally regulated simply do not have to comply with California requirements.

The differences between state regulated plans and federally regulated plans can be extensive for both patients and dentists. As a result, understanding what a plan will cover and what a patient must pay out-of-pocket can be difficult and frustrating. Patients don’t know where or how to resolve conflicts with their plan and dentists lack clarity on which rules the dental plans must follow. 

With over 40% of Californians enrolled in dental plans that are regulated under federal law, it is vital for patients and providers to be aware of which regulations and laws apply. While states do not have the authority to regulate these federal ERISA plans, additional transparency for patients and providers can be put into place at the state level. 

AB 952 would require dental plans, at the time of determination of coverage for patient eligibility, to disclose to the provider whether the patient’s dental coverage is federally regulated and subject to federal compliance. It would also require that the phrase “ERISA” be displayed prominently on the front of the patient’s insurance information. This simple transparency measure will benefit patients and dentists without unduly burdening dental plans.

2. Workforce Shortages/Dental Office Staffing

Dentistry is facing an ongoing workforce shortage of allied dental staff, exacerbated by the Covid-19 pandemic, particularly among unlicensed dental assistants (DA), registered dental assistants (RDA), and RDAs in extended function (RDAEF) positions. 

In November 2021, 87% of dental offices reported that when compared to pre-pandemic, it was extremely challenging to recruit and hire dental assistants. In the same survey, 44% of dental offices identified that trouble filling vacant staff positions has limited their practice’s ability to treat more patients. Additionally, it is estimated that over the last 10 years, there has been a nearly 50% decline in the number of first-year enrollment in dental assistant education programs.

CDA is pursuing both immediate and long-term solutions through recruitment and training programs, legislation, and state budget funding to improve dental career pipeline opportunities:

AB 481 – Dental Assisting Workforce (CDA-Sponsored): This legislation by Asm. Wendy Carrillo (D-Los Angeles) would:

    • Shorten the time it takes for an RDA to go through on the job training from 15 months or 1280 hours to 800 hours, the current standard for RDA education programs.
    • Streamlines the process for out of state dental assistants to apply for California RDA licensure.
    • Update scope of practices for DA, RDA, RDAEF positions to reflect modernization in dental technologies that are not currently addressed in the dental practice act, like placing clear aligner “buttons” to aid orthodontic treatment. 
    • Remove unnecessary barriers for dental assistants to take additional training and gain new permitted skills. 
    • Implement clarifications around dental assistant training that have been caught up on the dental board regulatory process for six years. 

This bill will assist in getting more RDAs fully trained and licensed quickly to meet patient demand while maintaining quality of care. It will also help ensure the dental assisting career ladder provides meaningful career growth opportunity and is attractive to those entering the dental workforce.

Workplace Development Budget Investments: Last year’s state budget made major investments in health care workforce development and provides great opportunities to address dental staffing needs. CDA is especially supportive of an additional $45 million to the High Road Training Partnership program, which will help its expansion into health career assistance, and $175 million to a newly created Apprenticeship Innovation Program that will provide funding in sectors where apprenticeship training has not traditionally been common. CDA is engaged with the Newsom administration on opportunities to establish dental assisting apprenticeships and will continue to advocate for workforce funding robust enough to support the development of non-traditional apprenticeship programs in healthcare and the dental workforce. 

3. State Budget: Protecting Medi-Cal & Health Equity Investments

CDA is very pleased that Gov. Newsom’s 2023-24 budget proposal protects recent investments in oral health access and equity for the state’s most vulnerable populations. While the state’s budget deficit will require some adjustments and caution overall, the historic progress in this area in recent years must not be jeopardized. 

The restoration of Medi-Cal Dental benefits eliminated during the Great Recession, substantially improved reimbursement rates (40% increases or more across most covered dental services) and other significant programmatic changes have led to meaningful and sustained results in the Medi-Cal Dental Program, which provides coverage for more than half of children and a third of adults in California – 14 million residents in total. In the past five years, the state has seen a 30% increase in Medi-Cal Dental providers, a rate that is consistently increasing each year, as well as a doubling of patient utilization of Medi-Cal dental services since the Great Recession. 

In addition, last year the state made a first-of-its-kind investment to address the crisis in access to dental care for patients with special health care needs, with $50 million to build and expand specialty dental clinics and outpatient surgery centers. The state also allocated $10 million for community-based clinical education rotations for dental students to expand access to care in dental health professional shortage areas (DHPSAs).

4. Children's Dental Health Month - ACR 10 (CDA-Sponsored)

February is National Children’s Dental Health Month (NCDHM), an important nationwide tool for raising awareness about the importance of childhood oral health and the role it plays in children’s overall health. NCDHM brings together thousands of dedicated professionals, healthcare providers, and dental educators to promote the benefits of good oral health to children, their caregivers, teachers, and others.

This year, NCDHM is an opportunity to highlight the state’s recent accomplishments in improving access to dental care and reinforce the importance of keeping children up to date with their dental care after the delays caused by the COVID pandemic. CDA, in partnership with the California Society of Pediatric Dentistry, is sponsoring ACR 10 by Asm. Akilah Weber (D-San Diego), declaring February as Children’s Dental Health Month in California. 

Nationwide, tooth decay is the number one chronic infectious disease among children, although it is largely preventable. In California, 6-in-10 of third graders have experienced tooth decay and 22% have untreated tooth decay. Disparities related to race/ethnicity and socioeconomic status exist with 72% of disadvantaged children experiencing some form of tooth decay. When left untreated, cavities can cause pain and infections that may lead to problems with eating, speaking, playing and learning. California children miss approximately 874,000 days of school each year due to dental problems. Developing good habits at an early age and scheduling regular dental visits helps children to get a good start on a lifetime of healthy teeth and gums. 

5. Direct-to-Consumer Orthodontic Protections

Providing dental care that involves the movement of teeth without a proper evaluation, including X-rays, can lead to serious patient harm, such as loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of direct-to-consumer business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care. CDA will continue to work with the appropriate enforcement entities, including the dental board, to push for increased patient safety while pursuing improved statutory and regulatory enforcement.


Updated April 2023