Healthy Families elimination: What dental providers need to know

Earlier this year, Gov. Jerry Brown proposed and the Legislature approved the transition of all 875,000 of the children currently enrolled in the Healthy Families Program to the Medi-Cal program, which includes coverage for medical, vision, as well as their dental care. CDA has prepared this information for members about the transition.

Transition timeline
The administration’s plan currently has the transition occurring in several phases, with approximately 200,000 children transitioning no sooner than Jan. 1, and then other cohorts in March, April, August and September. There continues to be a great deal of advocacy supporting a delay in the transition, but at this time, the Department of Health Care Services (DHCS) intends to begin as planned on Jan. 1. However, it is important to note that DHCS is required to get permission from the federal administration before the transition can begin.

The state will transition children in the following counties beginning Jan. 1:  Alameda, Riverside, San Bernardino, San Francisco, Santa Clara, Orange, San Mateo and San Diego. In addition, the state announced children in the following counties will transition on March 1: Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Tulare, Sacramento, Napa, Solano, Sonoma, Yolo, Monterey, Santa Cruz, Santa Barbara and San Luis Obispo. Finally, the state has identified five counties that technically meet the criteria needed to conduct the transition, but it hopes to conduct more focused dental provider outreach: Alpine, Sierra, Inyo, Mariposa and Yuba. The state has not yet announced the transition timeline for remaining counties.

No dental managed care expansion
CDA successfully advocated against the administration’s proposal to expand Medi-Cal dental managed care statewide by moving the children from the Healthy Families Program managed care plans to new Medi-Cal managed care plans during the transition. Instead, children will be moved into the Denti-Cal fee-for-service system in all counties — except in Sacramento and Los Angeles where dental managed care currently exists — effectively preventing expansion of Medi-Cal dental managed care as a result of this transition.

Building network capacity
One key issue of concern for DHCS is whether it can develop and maintain a sufficient network of dentists within the current Medi-Cal structure to provide dental care to all 875,000 new enrollees. To that end, DHCS is conducting provider outreach efforts through surveys and direct phone calls to encourage current Healthy Families providers to become Denti-Cal providers if they are not already and to encourage current Denti-Cal providers to serve more patients. DHCS also plans to communicate with all newly licensed dentists to encourage their enrollment in the program to serve these new beneficiaries. To communicate with DHCS about your capacity to serve children as they transition from the Healthy Families Program to the Medi-Cal program, you can complete and submit this short form.

DHCS plans to help dentists who are interested in becoming Denti-Cal providers by expediting their enrollment in the program and helping to ensure the application process goes as smoothly as possible. While CDA continues to raise concerns regarding the exceptionally low rates paid to dentists providing care through the Medi-Cal program, DHCS has made clear, however, that an increase in the Medi-Cal rates paid to providers is not part of the current plan. Find out more about becoming a Denti-Cal provider.

Dentists who currently serve Healthy Families children and who are also Medi-Cal dental services providers (either through direct enrollment in the Denti-Cal program or through a Medi-Cal dental managed care plan) may continue to see their patients as they transition to Medi-Cal if they are affiliated with the same plan. DHCS will notify families when their children are transitioned, and DHCS is considering the feasibility of a process to notify providers when their patients transition from one program to the other. To communicate with DHCS about your interest and capacity to serve children as they transition from the Healthy Families Program to the Medi-Cal program, please complete and submit this short form.

Dentists currently serving children through the Healthy Families Program who do not wish to continue to serve them after their transition to Medi-Cal should notify the dental plans with whom they are currently contracted as soon as possible and notify DHCS by completing and submitting this short form.  Dentists will also want to notify patients, advise them of the importance of continued care, support them in finding alternative care by referring them to the local dental society or advise them to contact DHCS at 1.800.322.6384.

CDA activities

CDA has been actively participating and representing our members and their patients in all of the administration implementation meetings and has testified in the many legislative hearings held over the last few months regarding the Healthy Families transition. CDA will continue to actively engage with the administration and with the Legislature, including during the upcoming Legislative Special Session that will be called by the governor to address health care issues.

In an effort to provide streamlined, simplified information to its members, CDA also hosted a live, interactive webinar on Nov. 2 to help dentists better understand the upcoming transition of children enrolled in the state’s Healthy Families Program to Medi-Cal. Webinar attendees gained a more detailed understanding of the transition plan, continuity of care issues and the DHCS’s outreach efforts to support dentists interested in being Denti-Cal providers.

CDA intends to host additional webinars in the months ahead. 

CDA will keep members informed as this issue progresses. For more information, please contact Nicette Short at CDA at nicette.short@cda.org or 916.554.4970.