Dental News - Report shows Denti-Cal reimbursement rates lagging

Dental Tribune USA

Tue. 18 August 2015

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SACRAMENTO, Calif., USA: A new review of the California’s Denti-Cal program provides further evidence that current rates are insufficient and that there has been a significant decline in participating providers since 2008, according to the California Dental Association. The report from the state Department of Health Care Services shows that while there has been a nearly 40 percent increase in enrolled children and 77 percent increase in enrolled adults, there has been a double-digit decrease in providers in that same timeframe.

The report also shows current provider reimbursement rates lag behind other comparable states, highlighting that California’s reimbursement rates for the 25 most common Medicaid services fall significantly short of those in the similarly sized states of New York, Texas and Florida, according to the CDA. California’s rates are only 31 percent of the national average for commercial insurance.

In response to growing concerns about lack of access to care for Denti-Cal patients, the recently enacted 2015-16 state budget reversed a 10 percent reimbursement rate cut that took effect in 2013. However, the report, which is required by the Legislature, demonstrates much more work is still needed, according to the CDA.

“We appreciate how the new leadership within the department has focused on the Denti-Cal program, and releasing this comprehensive review of reimbursement rates should provide helpful guidance to the governor and Legislature in the work that remains to rebuild the Denti-Cal program,” said CDA President Walt Weber, DDS. “The reversal of the 10 percent cut was an important and greatly appreciated first step, but our hope is that in the special session and in discussions on the federal waiver being held this summer legislators and the department recognize that a multi-faceted approach is necessary to ensure access to care for all eligible children and adults.”

The special legislative session is focused specifically on stabilizing and increasing Medi-Cal funding.

“Targeted rate adjustments along with other program improvements will increase access to care for vulnerable populations and enable more dental providers to participate in the program,” Weber said. “Oral health is important to overall health and the state needs to continue to make it a priority.”

(Source: California Dental Association)

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