Medi-Cal and School-Based Dental Services

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Spending Plan Ends Rate Cut for Dentists in Medi-Cal, but Maintains Other Recession-Era Cuts to Health Services

In 2013, California began implementing a 10 percent cut to payments for certain providers, including dentists, who accept patients enrolled in Medi-Cal, the state’s health care coverage program for Californians with low incomes. The 2015-16 budget package repeals the rate cut for dental providers only effective July 1, 2015, using one-time special fund dollars to offset state General Fund costs. This change comes six months after the State Auditor released a report highlighting weaknesses in Medi-Cal’s dental program that limited children’s access to care.

The Legislature’s initial version of the 2015-16 budget package would have partially or entirely rolled back several other cuts to health and dental services that were adopted during and following the Great Recession in order to help close budget shortfalls. However, the budget agreement reached with Governor Brown deleted these provisions, leaving these recession-era cuts in place during 2015-16. The budget package:

  • Maintains the 10 percent payment cut to certain types of doctors and other Medi-Cal providers. Providers and advocates argue that this reduction discourages providers from participating in Medi-Cal or accepting new patients, potentially hindering access to services for the more than 12 million Californians enrolled in the program. The Legislature initially proposed to roll back half of this payment cut for all providers in 2015-16. One of the goals of the special legislative session on funding options for certain health and human services programs (see page 14) is to identify ongoing revenues to support a payment rate increase for Medi-Cal providers.
  • Does not restore the full range of dental benefits for adults enrolled in Medi-Cal. State policymakers eliminated Medi-Cal dental benefits for adults in 2009, with some dental services reinstated in 2014. The initial version of the budget package approved by the Legislature would have fully restored adult dental benefits in 2015-16.
  • Does not reinstate other Medi-Cal benefits that were eliminated in 2009. In addition to dental services for adults, state policymakers eliminated several other Medi-Cal benefits that are not required by federal law: acupuncture, audiology, chiropractic, incontinence cream and washes, optician/optical lab, podiatry, and speech therapy. The initial version of the budget package approved by the Legislature would have reinstated these benefits, with the exception of chiropractic services, in 2015-16.
  • Does not re-establish school-based dental services. The California Children’s Dental Disease Prevention Program ceased operating after losing all General Fund support – roughly $3 million – in 2009. This program provided school-based dental services, such as sealants and fluoride rinses, to more than 300,000 primarily low-income children each year. The initial version of the budget package approved by the Legislature would have reinstated this program at cost of $3.2 million in 2015-16.

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