State’s Rate Review Shows Fewer Dental Providers Take Medi-Cal Patients

State health officials last week released a review of the rate structure for Medi-Cal dental coverage. It compared California’s payments to four other populous states — New York, Illinois, Florida and Texas. California paid less than three of them.

It also showed the change in dental provider participation in Denti-Cal — California’s Medicaid program for dental care — since 2008, and that number was particularly alarming to advocates.

According to the California Department of Health Care Services report released to the public July 2, there were 9,527 Denti-Cal providers in 2008. That number slipped to 8,173 in 2013. That’s a loss of 1,354 providers over five years —  a little over 14%.

Considering the millions of Medi-Cal beneficiaries added to the rolls in those five years, California is facing a serious dilemma, according to Alicia Malaby, director of communications at the California Dental Association.

Although the question of access was not directly raised by the DHCS rate review, the issue is clearly a problem, Malaby said.

“Based on the significant increase in beneficiaries covered and the decrease in the providers in the network during the same time period one can easily conclude that access to care is problematic in the Denti-Cal program,” Malaby said.

The rate review itself is not supposed to draw conclusions about access, or whether rate increases might be justified or not, according to Anthony Cava, information officer at DHCS.

“The statutory requirement is limited to a rate review,” Cava said in an email. “It does not call for department conclusions. Any rate increase in Medi-Cal would be handled through the administration’s regular budgetary process.”

Jennifer Kattlove, senior director of programs at The Children’s Partnership, believes any discussion of rates should include its companion piece — access. That’s especially true of a state review of those rates, she said.

“It’s missing the most important piece of information — how rates affect access,” Kattlove said. “It has been shown there’s a correlation between low rates and less access, but that’s missing from this report.”

According to the welfare code requirement for this rate review, “The director annually shall review the reimbursement levels for physician and dental services under Medi-Cal, and shall revise periodically the rates of reimbursement to physicians and dentists to ensure the reasonable access of Medi-Cal beneficiaries to physician and dental services.”

That does not include a requirement for any opinion on changing rates — though the rate review did include a mention of access, after citing a number of legal decisions around rates:

“Given these recent legal actions, DHCS must reiterate that a reimbursement rate and its relationship to beneficiary access is not a strict or linear one. Instead, there are a multitude of factors that must be considered and addressed when ensuring appropriate access to covered services,” the report said.

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