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CalAIM now in effect, implements oral health improvements strategies for Medi-Cal program

January 26, 2022 3856

Quick Summary:

The CalAIM benefits are an extension of the Dental Transformation Initiative, a five-year pilot program that implemented several benefits to increase the use of preventive dental services for children, prevent and treat more early childhood caries and increase continuity of care for children.

California’s transformative Medi-Cal proposal, California Advancing and Innovating Medi-Cal, is now in effect with two new statewide benefits that aid the Medi-Cal Dental Program.

CalAIM is a multiyear initiative by the Department of Health Care Services that aims to improve the quality of life and health outcomes of the Medi-Cal population by implementing broad delivery system, program and payment reform across Medi-Cal.

Plans to implement CalAIM were placed on hold in 2020 due to the pandemic but reintroduced in the state’s 2021 budget proposal and approved in December.

The program, which went into effect Jan. 1, authorizes supplemental payments for select preventive dental services for children and adults and the continuity of care — making these benefits available with fee-for-service providers and at safety net clinics statewide. The program also extends preventive dental services to dental managed care.

Medi-Cal providers and patients will also be able to take advantage of two new statewide benefits recently added to the program: The Caries Risk Assessment bundle for children and silver diamine fluoride for young children and high-risk groups — a benefit CDA has been advocating to be included in the Medi-Cal program for several years, including through legislation introduced in 2019 that ultimately did not pass.

The CalAIM benefits are an extension of the Dental Transformation Initiative, a five-year pilot program that implemented several benefits to increase the use of preventive dental services for children, prevent and treat more early childhood caries and increase continuity of care for children.

The approval and implementation of CalAIM reflects the success of DTI and CDA’s multiyear advocacy campaign to increase provider rates and expand access to care within the Medi-Cal Dental Program. CDA assisted the state in implementing the program, which brought $750 million in innovative payment models and incentive payments to California dentists. The DTI program, along with the Proposition 56 provider rate increases, restoration of adult dental benefits and improvements to administrative and enrollment barriers, has stabilized and improved the Medi-Cal Dental Program and increased provider enrollment by 20% over the last five years.

Information about each CalAIM benefit can be found on the Department of Health Care Services’ CalAIM dental page. To learn about changes in the Medi-Cal Dental Program, sign up to be added to the provider email distribution list.