California state budget increases Denti-Cal reimbursement rates
July 30, 2018
Sacramento — California's 2018-19 state budget includes funding that would increase reimbursement rates for providers in Denti-Cal, the dental program within the state's Medicaid (Medi-Cal) program, according to the California Dental Association.
The budget, signed by Gov. Jerry Brown, dedicates $210 million from a state tobacco tax revenue to Denti-Cal providers, up $70 million from last year's amount. With federal matching dollars, the total will equal up to $600 million in new funding for the program.
The California Dental Association said in an announcement that the increased funding is part of an effort to improve the Medi-Cal dental program and increase access to oral health care for the state's 13.5 million Medi-Cal enrollees.
"We hope this new funding will allow more dentists to participate in the program, which has suffered from chronic underfunding, including reimbursement rates among the lowest in the nation," said Dr. Natasha Lee, California Dental Association president.
The proposals in the 2018-19 budget includes:
- Maintaining the 40 percent supplemental payments approved in 2017. In 2017, the state allocated $140 million of the tobacco tax funds for Denti-Cal provider payments, which were disbursed as a 40 percent reimbursement supplement on hundreds of CDT codes, including restorative, endodontic, prosthodontics, surgical and adjunctive services.
- Adding incentives for the top 26 utilized CDT codes, including adult dental preventive services, periodontal services and some diagnostic services.
- Increasing reimbursement to support the additional time needed to treat individuals with special health care needs.
- Increasing reimbursement for general anesthesia and intravenous sedation to create parity with medical providers.
"In addition, the one-time allocation of funding toward student loan repayments will allow new dentists to serve Denti-Cal beneficiaries in areas that lack adequate providers," Dr. Lee said. "We hope these changes demonstrate a real commitment from state lawmakers to bring in more providers and improve the oral health of Californians."
According to the CDA, low reimbursement rates have been one of the troubling aspects of the Denti-Cal program for years. However, the additional funding brings reimbursement rates on some of the most common services up to 70 to 90 percent of commercial rates.
The new rate package went into effect July 1. The payments will be applied to both Medi-Cal dental fee-for-service and dental managed care delivery systems, according to the California Dental Association. The California Department of Health Care Services will post detailed methodologies for the proposals on its website, dhcs.ca.gov, before Sept. 30.
According to the California Dental Association, providers do not need to take any action. They can simply continue normal billing and supplemental payments will be automatically added to payment checks.