CDA Major Issues & Priorities

1. SB 1369: Predatory Dental Insurance Fees (CDA-Sponsored)

CDA is sponsoring legislation to curtail the usage of virtual credit cards (VCCs) as a method of payment used by dental insurance companies. Dental plans are more frequently using third party companies to issue payments to dental offices through VCCs, which take a processing fee of 2-5%, plus the merchant transaction fee through their credit card terminal. These predatory fees can take up to 10% off the top of the payment owed by the plan.

VCC payments in many cases become the default payment method. While dental practices can opt out of VCC services, the opt-out process is often difficult and not always permanent. VCC companies are known to reinstitute the payment method with its excessive fees after the provider opts out, even as soon as the very next payment. Furthermore, requesting an alternative payment method can delay receipt of that payment, waste administrative staff time and create challenges for office accounting.

Ultimately, this trend takes health care dollars away from patient care. SB 1369 by Sen. Monique Limon (D-Santa Barbara) will address this issue by:

  • Requiring that the default payment method must be one that does not include a fee. If a provider would like to use VCCs as their primary payment method, they may do so, but only by written authorization – and they may opt out of VCCs again at any time.
  • Requiring plans to provide notice of any fees associated with a particular payment method and advise dentists of alternative methods of payment along with clear instructions as to how to select an alternative method of payment.
  • Requiring dental plans to provide notification of any profit-sharing or fee arrangement with the VCC company.

As dental patients continue to seek care deferred during the COVID-19 pandemic, timely access to care is imperative as ever. The fees associated with virtual credit cards can cause a significant increase in dental office overhead costs, leading to reduced office hours, limited patient scheduling and delayed care. It is essential to reduce predatory practices of dental plans and VCC companies to maximize the health care dollars going to patient care. SB 1369 passed in the Senate without any “no” votes and will now be considered in the Assembly.

2. Dental Staffing Shortages/Dental Board Sunset Review

Approximately every four years the state Dental Board, like other regulatory boards, undergoes a standard evaluation by the state legislature, called sunset review, of roles and responsibilities of the board and the laws it enforces. CDA strongly supports continuation of the existing Dental Board and will be advocating for the following issue to be included in this year’s sunset review legislation, SB 1453 by Sen. Angelique Ashby (D-Sacramento):

Dental Assistant Licensure Pathways

Dentistry is facing a critical shortage of dental staff, exacerbated by the COVID-19 pandemic, particularly among dental assistants. CDA is proposing new ways to become a registered dental assistant (RDA) to help expand this workforce:

  • Streamline and shorten the existing 15 months of on-the-job training to 800 supervised hours, inclusive of educational and clinical experience. 800 hours is the current standard in RDA educational programs, so this will create parity between the two options.
  • Allow individuals who move to California and hold a certified dental assistant certificate to apply for RDA licensure if they meet certain criteria.

Pediatric Sedation Permits

A law that took effect in 2022 unintentionally prevents qualified pediatric dentists from sedating their patients who are 13 and older. CDA is seeking a technical fix to allow pediatric dentists who hold a pediatric minimal sedation permit to continue offering minimal sedation for treatment that requires it.

3. State Budget: Specialty Dental Clinic Grant Program

CDA is opposed to the funding cut proposed in the 2024-25 May Revise budget that would eliminate the Specialty Dental Clinic Grant Program. In 2022, CDA and a broad coalition of disability, consumer and provider groups advocated for $50 million in-one time funding to establish the program, which would fund the construction of at least 10 new dental clinics for patients with special needs and disabilities. The intent of the program is to increase capacity and access to care for those who cannot receive care in traditional dental settings. Currently capacity is limited and often centralized in urban areas, so patients and their families are often forced to wait, sometimes up to two years, and travel long distances to receive basic oral health care.

CDA recognizes the significant budget shortfall and the need to make difficult decisions. However, the elimination of these funds will undermine the potential progress in expanding dental access for individuals with special health care needs. The budget shortfall this year further demonstrates the need to implement innovative one-time programs to address the long-term challenges facing vulnerable populations. California Health Facilities Financing Authority (CHFFA) worked quickly to develop application guidelines and requirements, with the first round of applications closing on April 1, 2024. Now, with outstanding applications for shovel-ready projects, the future of the grant program is at risk. The Governor’s proposed budget initially delayed, and then eliminated, the grant funding. CDA and our coalition partners are urging the legislature and Governor Newsom to maintain this crucial funding.

4. AB 2701: Medi-Cal Coverage for Adult Dental Cleanings (CDA-Sponsored)

Current Medi-Cal Dental benefits cover two cleanings and exams per year for those up to age 21. However, once an individual is age 21+, Medi-Cal only covers one cleaning and exam per year. The standard of care for most people is two dental cleanings and exams per year to prevent long-term dental disease, while some high-risk adults may need up to four cleanings annually. Unfortunately, prevalence of dental disease and tooth loss is disproportionately high among individuals who have lower incomes. Individuals eligible for Medi-Cal are likely to be most in need of additional preventive visits and the most harmed by only receiving one cleaning per year.

CDA is supporting AB 2701 by Asm. Carlos Villapudua (D-Stockton), which would expand California’s Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21+ when medically necessary. Over half of all states cover two adult cleaning and prevention visits a year, while California does not currently offer this basic preventive benefit. AB 2701 passed in the Assembly without any “no” votes and will now be considered in the Senate.

5. 2024 Ballot Measure – Medi-Cal Funding

CDA has joined with the Coalition to Protect Access to Care to file a ballot measure for the November 2024 election that will protect and expand funding for California’s Medi-Cal program. The measure would permanently secure new funding for Medi-Cal dental services, student loan repayments, health care workforce development and other programs.

Medi-Cal currently provides medical and dental coverage to 15 million low-income Californians (1/3 of all residents and half of all children), making it the largest provider of medical and dental insurance in the state. The program continues to grow and, after decades of underfunding, it needs long-term, permanent funding solutions.

The ballot measure is an important opportunity to build on Medi-Cal’s recent progress and ensure health care dollars stay in the health care system. The restoration of Medi-Cal dental benefits that had been eliminated during the Great Recession, substantially improved reimbursement rates (40% increases or more across most covered dental services) and other major programmatic changes have led to meaningful and sustained results in the Medi-Cal dental Program. 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.

The ballot measure would provide an ongoing funding source by permanently extending the state’s recently renewed “managed care organization” (MCO) tax on health insurance companies. The revenue would be dedicated for Medi-Cal and specific health programs (as opposed to the state’s general fund like previous MCO taxes) and Medi-Cal dental services would be among the programs receiving funds starting in 2027.

6. SB 1290: Adult Dental Care – Essential Health Benefits (Support if Amended)

The Biden Administration released a final rule in early April that gives states the option of adding adult dental care as an essential health benefit (EHB). Addition of adult dental services as an EHB would be a monumental step in recognizing dental care as critical for overall health and would set a minimum standard benefit for dental plans, in addition to bringing dental care to adults in California who still lack coverage.

EHBs are ten categories of services that health plans are required to cover per the Affordable Care Act, including pediatric dental care. Each state selects a health care plan as the “benchmark” that identifies the minimum coverage that health plans must offer in the state, which may go beyond the federal EHBs. The new federal rule means that California has the option to require health plans offered in the individual and small group markets to provide adult dental services.

California cannot change or select a new EHB benchmark plan without legislation. SB 1290 (Roth) would set a new EHB benchmark for California, and CDA is strongly urging that adult dental care be included.

Updated May 23, 2024