Basic Denti-Cal services for adults to be re-established May 1

Nearly five years after the state eliminated dental benefits for adult beneficiaries in the Medi-Cal program, many of those benefits are being restored as of May 1, 2014.

Faced with a multibillion-dollar deficit in 2009, the administration and the legislature eliminated coverage for routine dental care for adults in the Denti-Cal program beginning July 1 of that year. According to federal Medicaid law, dental services are only mandatory for children, and as part of a broad effort to eliminate the gap between revenues and spending, the optional program for adults, with a few exceptions for special populations, was defunded by the state.    

However, largely as a result of the pent up need for dental care, so visibly demonstrated at CDA Cares, the California Legislature re-established a basic adult dental program beginning on May 1. These services include:

  • initial oral examinations, radiographs/photographic images, prophylaxis and fluoride treatments;
  • amalgam and composite restorations;
  • prefabricated stainless steel, resin and resin window crowns;
  • anterior root canal therapy;
  • complete dentures, including immediate dentures; and
  • complete denture adjustments, repairs and relines.

This scope of adult benefits is not as broad as those provided by the program prior to the 2009 benefit elimination. The cost of the adult program remained a concern, but Sen. Darrell Steinberg’s commitment to re-establish benefits for adults enabled the state to bring the program back with an emphasis on prevention and basic restorative care. CDA continues to look for opportunities to advocate for the inclusion of more services in the program in the future.

Since July 2009, dentists participating in the Denti-Cal program have primarily been providing children’s care. Some dentists who had participated in the program may have ended their participation when the program dropped adult coverage, but may be interested in again treating adult Denti-Cal patients with a re-established adult program. If you are interested in providing care to adults when the program returns but have not billed Denti-Cal within the last year, CDA urges you to check your provider enrollment status. 

To verify your provider status with Denti-Cal, the Department of Health Care Services is creating an enrollment verification form that dentists will be able to complete and submit online to confirm their active status within the program. Denti-Cal informed CDA that this form may be up on the Denti-Cal website as this issue of the Update goes to press, so check www.denti-cal.ca.gov for its availability. Also, you can always get assistance by calling the Denti-Cal Provider Telephone Service Center at 800.423.0507.  If you are already a Denti-Cal dentist, you may want to make an outreach to the parents of the children you see in your practice to let them know that their basic dental care needs will again be covered by Denti-Cal.

The complete list of procedure codes covering diagnostic, preventive, restorative, endodontic and prosthodontic care for adults in the Medi-Cal program is in the Denti-Cal Bulletin, Volume 29, Number 14, published in August 2013, and available at www.denti-cal.ca.gov.

Additionally, CDA Presents the Art and Sciences of Dentistry will be presenting a lecture on the restored adult benefit program, including covered procedures and payment policies in Denti-Cal from 8 to 11 a.m. on Friday, May 16, 2014, at the Anaheim Convention Center.