The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. This effort is the result of years of activity to improve the Medi-Cal dental program and increase access to oral health care for the state’s 13.5 million Medi-Cal enrollees.
The funding will provide supplemental payments to increase reimbursement rates for Denti-Cal providers throughout the state. With federal matching dollars, the total will equal up to $600 million in new funding for the program.
One completely new aspect in this year’s budget is an additional one-time allocation of $30 million toward a program that would repay student loans for dentists who commit to serving Denti-Cal beneficiaries and locate their practice in a county or region that lacks adequate providers. Award criteria will be developed by the California Department of Health Care Services and the Office of Statewide Health Planning and Development, with stakeholder input. CDA is enthusiastic about the program’s potential to attract dentists to underserved areas of the state and the program’s potential to support care for California’s neediest population.
The state last year allocated $140 million of Proposition 56 funds for Denti-Cal provider payments, which were disbursed as a 40 percent reimbursement supplement on hundreds of CDT codes, including restorative, endodontic, prosthodontic, surgical and adjunctive services. Preventive and periodontal services were not included in last year’s increases, but after significant advocacy by CDA and other advocacy groups, both of these treatment categories will receive increases in 2018-19.
The proposal for the 2018-19 budget year includes:
- Maintaining the 40 percent supplemental payments approved in 2017.
- Adding incentives for the top 26 utilized CDT codes, including adult dental preventive services, periodontal services and some diagnostic services.
- Increasing reimbursement to support the additional time needed to treat individuals with special health care needs.
- Increasing reimbursement for general anesthesia and IV sedation to create parity with medical providers.
The new rate package will be effective July 1, 2018. The payments will be applied to both Medi-Cal dental fee-for-service and dental managed care delivery systems. DHCS will post detailed methodologies for these proposals on its website before Sept. 30. Providers do not need to take any action. They can simply continue normal billing and the supplemental payments will be automatically added to payment checks.
Low reimbursement rates have been one of the troubling aspects of the Denti-Cal program for many years, but these new investments are a significant effort to reverse that problem, bringing reimbursement on some of the most common services up to 70-90 percent of commercial rates. Beyond rate advocacy, CDA has worked closely with DHCS on reducing administrative burdens, leading to several promising program changes that make it easier than ever for dentists who wish to become a Denti-Cal provider:
- New Denti-Cal provider application reduces time and paperwork. The average time from application to approval is now 14 days. Additionally, dentists may receive one-on-one assistance from an enrollment specialist at an in-person workshop or by calling the Denti-Cal Customer Service line at 800.423-0507.
- New webinars and in-person trainings. Continuing education credit can be earned as part of an extensive training program for new and experienced dentists and their staff. Individual and on-site training assistance is also available.
- The Dental Transformation Initiative is currently providing additional incentives for treating children under age 6.
- New online provider portal launched by Denti-Cal lets providers log in and check treatment authorization request status and history, claim status or payment history.
Find more information about the Denti-Cal program on the Denti-Cal website or contact Denti-Cal at 800.423.0507 or CDA Public Affairs at 916.554.4984. To automatically receive the monthly Denti-Cal Bulletin and related communications, sign up for the DHCS email listserv.