California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Western Dental To Stop Accepting New Patients Under Denti-Cal

Citing low reimbursement rates, Western Dental -- one of the largest Denti-Cal providers in the state -- said it will stop accepting new patients covered by the program, the Sacramento Business Journal reports.

Denti-Cal is the dental program for Medi-Cal, California's Medicaid program (Robertson, Sacramento Business Journal, 5/20).

Background

Denti-Cal serves about 2.7 million adults and children. That number could increase to 6.4 million as the result of the state's Medi-Cal expansion.

Advocates warn that the increase in Medi-Cal beneficiaries could add pressure to the dental program, which already has been facing problems in recent years (California Healthline, 4/21).

According to the Business Journal, California dentists have not received a pay increase from the program since fiscal year 2000-2001 and saw a 10% rate decrease in 2013.

Details of Change

According to the Business Journal, Western Dental will stop accepting new Denti-Cal patients at 13 of its offices on June 1. In addition, the company will completely close two other offices.

Western Dental CEO Simon Castellanos said, "This is just the first wave," noting that the company likely will start transitioning more offices to "traditional insurance" each month.

Reasons Behind Change

Western Dental said it decided to stop accepting new patients covered by the public program because its business was no longer viable due to low reimbursement rates and a sharp uptick in demand for services.

According to the Business Journal, Western Dental serves between 650,000 and 700,000 patients annually. Under the Affordable Care Act's Medicaid expansion, Western Dental's patient population shifted to a higher proportion of low-income patients who need more care.

Castellanos said, "Denti-Cal is broken and driving away providers," adding, "It's not a sustainable model" because reimbursement cuts are low while the company's expenses have continued to grow.

Reaction From State Officials

Tony Cava -- a spokesperson for the California Department of Health Care Services, which oversees Denti-Cal -- said, "The department is very concerned about the potential impacts to Medi-Cal beneficiaries resulting from service reductions by Western Dental."

According to the Business Journal, state officials have said they will monitor the issue to ensure patients have adequate access to dental services.

In addition, officials said they are working to obtain additional resources for:

  • Existing providers who increase the number of Denti-Cal patients they accept; and
  • New providers who commit to dedicating part of their practices to serving Denti-Cal patients.

Groups Seek More Resources for Low-Income Dental Care

Meanwhile, a coalition has started a campaign aimed at persuading Gov. Jerry Brown (D) and state lawmakers to include in the state budget extra resources to help provide dental services to California's low-income population, the Business Journal reports.

In addition, California's congressional delegation in a letter to Brown last week said that Denti-Cal's low reimbursement rates are having a negative effect "on the number of dentists in California still willing and able to participate in the program."

The group added, "We urge you to prioritize improvements to the Denti-Cal program in this year's budget" (Sacramento Business Journal, 5/20).

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