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CDA: Reimbursement rates lagging

Denti-Cal provider base shrinking

July 07, 2015

By Craig Palmer

Headshot of Dr. Walt Weber
Dr. Weber
Sacramento, Calif. – Current Denti-Cal reimbursement rates are insufficient and there has been a significant decline since 2008 in participating providers, the California Dental Association said in citing a state health department review of the Medicaid dental program.

The Department of Health Care Services reported a double-digit decline in providers while Denti-Cal was enrolling nearly 40 percent more children and 77 percent more adults. The report also shows that California's reimbursement rates for the 25 most common Medicaid dental services fall significantly short of those in New York, Texas and Florida and that California's rates are only 31 percent of the national average for commercial insurance, the CDA said in a news release posted July 6 at cda.org.

The recently adopted 2015-2016 state budget reversed a 10 percent reimbursement rate cut that took effect in 2013, but the report mandated by the state Legislature indicates more work is needed to address the shrinking provider network, the CDA said.

"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 Dr. Walt Weber, CDA president.

"The reversal of the 10 percent cut was an important and greatly appreciated first step, but our hope is that in the [Legislature's] 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," Dr. Weber said. The special session is focused specifically on stabilizing and increasing Medicaid funding.