Access, Monitoring Raised as Issues for Denti-Cal Restoration Starting May 1

State officials last week declared the Department of Health Care Services ready for the May 1 kickoff of partially restored dental services for adults as a Medi-Cal fee-for-service benefit, despite some criticisms of the department’s oversight. DHCS came under fire from the Legislative Analyst’s Office for inadequate monitoring of access to dental providers.

“We are on schedule to implement the partial restoration of the optional adult dental services on May 1 and we are very excited about that restoration,” said Mari Cantwell, chief deputy director at DHCS.

In his proposed budget for 2013-14 spending plan, Gov. Jerry Brown (D) agreed to restore some Denti-Cal benefits for adults over the next two years. Denti-Cal is part of Medi-Cal, California’s t program. That restoration follows a succession of cuts and court orders since 2009 over the issue. In 2011, the state received CMS approval to drop the optional benefit, but a 2013 ruling in the 9th U.S. Circuit Court of Appeals declared that decision illegal.  

According to Cantwell, the restoration of 32 adult dental procedures represents about 85% of the services previously provided through Medi-Cal, at approximately 55% of the costs.

Cantwell said the department notified Medi-Cal beneficiaries of the Denti-Cal restoration in January and DHCS plans another mailing in May.

“And we’ve streamlined provider enrollment to make sure we have enough providers,” Cantwell said.

But according to officials from the Legislative Analyst’s Office, the department has not done enough to monitor utilization and provider participation or ensure access to dental services.

“In our view, these monitoring efforts are inadequate and do not sufficiently address meaningful access to care in fee-for-service Medi-Cal,” said Felix Su, a fiscal and policy analyst for the LAO.

“For example, simply reporting the number of providers who have ever submitted a claim to be reimbursed for Medi-Cal services does not tell you how many FTE providers are accepting new Medi-Cal patients in their practices,” Su said. “This isn’t just a concern from our perspective. The federal CMS has indicated that it is important for state agencies to monitor how many of their providers are actively accepting new [Medi-Cal] patients in their practices.”

Angela Blanchard, legislative advocate for the California Dental Association, had similar misgivings about the number of dental providers meeting higher demand, in part because of successful Medi-Cal expansion efforts.

“We have similar concerns about how access will be measured and how utilization will be measured,” Blanchard said.  

DHCS Director Toby Douglas said any new effort on the dental side would cost more money and detailed monitoring of access is not a simple task. Douglas said he appreciated the LAO analysis.

“We are carefully reviewing access. There is no one way to measure access,” Douglas said. “You have to look at it from multiple dimensions. Access isn’t just about looking at participation, it’s looking at how care is delivered.”

Related Topics

Capitol Desk Medi-Cal