Medi-Cal beneficiaries in Sacramento County may disenroll from DMC plans and enroll in FFS beginning in December

Dentists in the county should take steps to continue seeing current patients who leave a DMC plan
December 19, 2023
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Teenager in dental chair showing dentist location of discomfort.
Quick Summary: Medi-Cal beneficiaries in Sacramento County are receiving notices about the option to disenroll from their Dental Managed Care plan, and any individual in the county who newly enrolls in Medi-Cal will be automatically enrolled in dental fee-for-service instead of a DMC. Dentists in Sacramento County who are contracted with one or more Medi-Cal DMC plans must be enrolled as a fee-for-service provider to continue seeing existing patients who leave their DMC plan and enroll in FFS. See how to take action.

Changes to the Medi-Cal Dental Program may affect dentists and their Medi-Cal patients who reside in Sacramento County. Historically, all Medi-Cal members who reside in Sacramento County were automatically enrolled in one of Medi-Cal Dental’s three Dental Managed Care plans (Liberty, Health Net and Access Dental), while most Medi-Cal members in other counties receive their dental services through the state’s fee-for-service system.

Under federal requirements, the California Department of Health Care Services conducted a performance evaluation of all three Dental Managed Care plans. DHCS found that the plans did not meet parity in all the required measures when compared to the statewide fee-for-service average and that therefore the plans have provided inadequate quality of services. Consequently, effective Dec. 1, 2023, Sacramento Medi-Cal beneficiaries are allowed to be in Medi-Cal Dental’s FFS delivery system.

Medi-Cal beneficiaries in Sacramento County are receiving notices about the option to disenroll from their DMC plan. They can remain in their plan if they choose to and are not required to take any action. However, any individual in the county who newly enrolls in Medi-Cal will be automatically enrolled in dental fee-for-service instead of a Dental Managed Care plan. Approximately 614,000 beneficiaries in Sacramento County are expected to receive a notice.

Medi-Cal members residing in Sacramento County may only elect to join a DMC plan if they experience difficulty accessing necessary care under the existing time and distance standards of the DMC program. These members must call Medi-Cal Dental FFS to inform the call center representative that they are having difficulty accessing care. The representative will submit the member’s request to opt out and will help the member locate a provider.

Only dentists enrolled in FFS can continue seeing patients who leave DMC plans

If you are contracted with one or more Medi-Cal DMC plans, you must be enrolled as a provider in Medi-Cal Dental fee-for-service to continue seeing any existing patients who leave their DMC plan and enroll in Medi-Cal Dental FFS. Because you may start to see a drop-off in DMC patients, it is especially important that you recheck eligibility prior to treating Medi-Cal members if you are not an enrolled Medi-Cal Dental FFS provider.

If you are enrolled as a fee-for-service provider, you may begin to receive more calls from FFS Medi-Cal FFS patients who are looking for a dentist.

If you are interested in becoming a Medi-Cal FFS dental provider, visit the enrollment portal or contact the Medi-Cal Dental Program at 800.423.0507.

New DMC plans coming in 2025. Plus: patient verification of Medi-Cal eligibility required

The Medi-Cal Dental Program is in the process of procuring contractors for new Dental Managed Care contracts. Optional enrollment in a DMC plan in Sacramento County will be available until operations begin under the new DMC contracts.

Medi-Cal beneficiaries must verify eligibility annually. However, during the COVID-19 public health emergency, special federal rules suspended verification of Medi-Cal eligibility, allowing continuous coverage to ensure individuals were able to access care.

Now that the public health emergency has ended (as of May 11, 2023), all Medicaid programs throughout the U.S. must verify eligibility. Dentists are encouraged to share outreach materials with their Medi-Cal patients and post flyers to raise awareness that continuous Medi-Cal coverage has ended.

Read the Medi-Cal Dental Provider Bulletin for more information.

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