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New CalAIM proposal by DHCS promises broad Medi-Cal reforms, adds SDF as statewide benefit

November 25, 2019

Health care providers can expect to see major revisions to the Medi-Cal program over the next couple of years as a result of a new initiative by the Department of Health Care Services.

Released in late October, the California Advancing and Innovating Medi-Cal (CalAIM) proposal will implement “broader delivery system, program and payment reform across the Medi-Cal Program,” according to the proposal summary.

The CalAIM initiative grew out of discussions about how the state will make changes in the Medi-Cal program beginning in 2021 upon expiration of the current CMS 1115 waiver known as Medi-Cal 2020. The dental component of that waiver, the Dental Transformation Initiative, allocated $740 million in 2016-20 and aims to improve dental health outcomes for Medi-Cal children.

CalAIM is a first step in these efforts and includes the upcoming 2020 state budget negotiations between the Legislature and the governor. CDA will be highly engaged in ongoing discussions about program changes even though dental care represents only a small percentage of the overall Medi-Cal program. CDA was appointed to participate in one of four CalAIM workgroups and will advocate strongly for inclusion of dental incentives in the CalAIM proposal and continuity between the end of the five-year DTI pilot program and future program reforms.

New hope for SDF after SB 154 veto

Gov. Gavin Newsom in October vetoed CDA-sponsored legislation by Sen. Richard Pan that would have added silver diamine fluoride as a Medi-Cal Dental benefit, stating “expanding the options available for treating dental decay is a worthwhile policy goal, but this bill would require significant General Fund spending not included in the state budget. As such, this change should be considered in the annual budget process.” Despite the veto of SB 154, the new CalAIM proposal would add SDF as a statewide benefit in Medi-Cal and offer additional financial incentives to Medi-Cal dental reimbursements similar to the current DTI.

CDA will be advocating for these incentives with the CalAIM workgroups and Legislature to continue the improvements and state investments in the Medi-Cal dental program.


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