California Department of Health Care Services

Operations

• "Information shortcomings and ineffective actions" by DHCS are putting child beneficiaries at higher risk of dental disease.
• Only 43.9 percent of children enrolled in Denti-Cal had seen a dentist the previous year – the 12th worst among states that submitted data.
• Reimbursement rates for the 10 most common dental procedures were 35 percent of the national average – and haven’t risen since the 2000-2001 budget year.
• Eleven California counties had no Denti-Cal providers or no providers willing to accept new child patients covered by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono and Inyo counties.
• California might not have enough Denti-Cal-participating dentists to handle millions of new Denti-Cal beneficiaries as a result of the Affordable Care Act.
• DHCS had not adequately overseen its Denti-Cal administrative contractor, which had not "performed contract-required outreach for improving dental access in underserved areas."
• * With 13 million children and adults enrolled, Denti-Cal is the largest state-sponsored dental insurance program
• * Private contractor that administers Denti-Cal is Delta Dental. In 2016, the State of California awarded Delta Dental a new contract to provide administrative services for the Denti-Cal program, continuing the 42-year relationship

  Controversies

• Medi-Cal Dental paid to the doctors only 30% of what commercial insurers paid for the same procedures per October 2017 report; even though DHCS must annually review reimbursement levels for Medi-Cal dental services to ensure “reasonable access” for Medi-Cal beneficiaries pursuant to Welfare & Institutions Code §14079
• In San Francisco, 61,440 children were enrolled in Denti-Cal as of 2016, but only one pediatric dentist was accepting new patients as of Mar 2018; similarly, there were only 15 dentists that accepted new clients for 173,000+ adult patients