CDA efforts win victory for Denti-Cal providers

Denti-Cal providers received positive news regarding retroactive reimbursement cuts in Gov. Brown’s proposed 2014-15 budget released Jan. 9.  The spending plan does not include a 10 percent “clawback” of payments made since June 2011 when the state authorized Medi-Cal reimbursement cuts as part of its budget.

While the state began implementing prospectively a 10 percent provider rate cut last September, CDA strongly advocated against the state’s efforts to implement the retroactive payback, citing the devastating impact on the provider network and patients’ ability to access care.

The state’s move to forgive retroactive recoupments for all dental services in addition to other specified medical services and providers will save providers, including dentists, $217.7 million.

“We are pleased that Denti-Cal providers will not face these retroactive cuts in a program that is chronically underfunded,” said CDA President James Stephens, DDS. “CDA will continue to raise awareness about the need to address funding issues as well as establish an oral health infrastructure, including a state dental director to support public oral health programs.”

The Brown administration will not need legislative approval to forgive the repayments, but will need federal approval.

Despite this positive step, providers still face a 10 percent rate cut for future services regardless of the fact that California’s provider reimbursement rates already rank among the lowest in the nation.  CDA believes this is unsustainable, particularly as the state tries to accommodate millions of new patients as a part of health care reform.    

CDA will continue to work toward a legislative reversal of the prospective rate cut, and a coalition made up of CDA and other health care organizations continues to pursue a petition at the U.S. Supreme Court on whether the federal Centers for Medicare and Medicaid Services abused its discretion in granting the state permission to make the 2011 provider cuts.

Additionally, the governor’s budget includes $17.5 million to increase outreach activities relating to Medi-Cal dental services for children, ages 0-3, which will provide education for parents of young children about the importance of early dental care. CDA has been strongly advocating for the state to create a dental director position that could oversee such activity as part of a comprehensive statewide oral health program focused on preventive care.

CDA will continue to keep members informed on this issue through cda.org, the Update, and e-newsletters.