Report shows Denti-Cal reimbursement rates lagging

A new review of the state’s Denti-Cal program provides further evidence that current rates are insufficient and that there has been a significant decline in participating providers since 2008. Just released by the state Department of Health Care Services, the report shows that while there has been a nearly 40 percent increase in enrolled children and 77 percent increase in enrolled adults, there has been a double-digit decrease in providers in that same timeframe.

The report also shows current provider reimbursement rates lag behind other comparable states, highlighting that California’s reimbursement rates for the 25 most common Medicaid services fall significantly short of those in the similarly sized states of New York, Texas and Florida. California’s rates are only 31 percent of the national average for commercial insurance.

In response to growing concerns about lack of access to care for Denti-Cal patients, the recently enacted 2015-16 state budget reversed a 10 percent reimbursement rate cut that took effect in 2013. However, the report, which is required by the Legislature, demonstrates much more work is still needed.

“We appreciate how the new leadership within the department has focused on the Denti-Cal program, and releasing this comprehensive review of reimbursement rates should provide helpful guidance to the governor and Legislature in the work that remains to rebuild the Denti-Cal program,” said CDA President Walt Weber, DDS. “The reversal of the 10 percent cut was an important and greatly appreciated first step, but our hope is that in the special session and in discussions on the federal waiver being held this summer legislators and the department recognize that a multi-faceted approach is necessary to ensure access to care for all eligible children and adults.”

The special legislative session is focused specifically on stabilizing and increasing Medi-Cal funding.

“Targeted rate adjustments along with other program improvements will increase access to care for vulnerable populations and enable more dental providers to participate in the program,” said Weber. “Oral health is important to overall health and the state needs to continue to make it a priority.”

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The state's reversal of the 10 percent rate cuts for Denti-Cal providers, which have been in effect since 2013, is a positive first step in ensuring access to care for the program's beneficiaries. Gov. Jerry Brown and legislative leaders made an announcement of a budget deal that will allow the rate changes to take effect July 1 pending federal approval.

The length of the lines at each of the seven CDA Cares clinics held throughout the state since 2012 demonstrate how Denti-Cal fails to provide access to care. CDA Cares Sacramento was another prime example as many of the patients had no other choice to relieve the pain they were in other than lining up early in the morning at Cal Expo.

CDA's advocacy urging the state to fix the broken Denti-Cal program has captured the attention of lawmakers who expressed outrage in two legislative hearings about the program's failure to provide access to care due to glaring oversight issues and extremely low reimbursement rates. CDA members testified at two joint oversight hearings of the Senate Health Committee, Assembly Health Committee and the Joint Legislative Audit Committees in March.