New benefits for Denti-Cal adults in 2018

More than 7 million adults (21 years of age and older) enrolled in Denti-Cal, California’s Medicaid dental program, will have a fully restored package of dental benefits in 2018. The adult benefit package was drastically cut in 2009 due to the state budget crisis and was partially restored in May 2014. The restoration of the adult dental benefit services is a result of legislative action taken during the 2017-18 budget process.

Currently, adult benefits in Denti-Cal include basic preventive, diagnostic, restorative, anterior tooth endodontic treatment, complete dentures and complete denture reline/repair services.

The Department of Health Care Services is requesting federal approval to restore comprehensive adult optional dental benefits, subject to medical necessity and utilization controls, for eligible adults. Restored benefits will include, for example, laboratory processed crowns, posterior root canal therapy, periodontal services and partial dentures, including denture adjustments, repairs and relines. Denti-Cal dental benefits remain the same for children, pregnant women or adults in a skilled nursing or intermediate care facility.

Reinstatement of the remaining adult dental benefits requires federal approval prior to going into effect, which may take several months. CDA will continue to monitor the status of the federal approval and publish the latest information on cda.org.

Dentists should note that Denti-Cal beneficiaries will be receiving a letter notifying adults of their new benefits in November or December 2017 and may reach out to dental offices with questions.

DHCS will update providers with relevant details in upcoming Provider Bulletins and the Provider Handbook prior to implementation of these changes in 2018.

Data from the DHCS indicates that less than one quarter of adults in the program had any dental visits in the last year. Dentists interested in becoming a Denti-Cal provider are encouraged to learn more about the program. Recent Denti-Cal program improvements make it easier to enroll as a provider, offer innovative incentive programs for increasing prevention in young children and increase reimbursement through forthcoming Proposition 56 supplemental rate payments.

For more information regarding the Denti-Cal program, please contact 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.

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