Earlier this month, the California Department of Health Care Services released a review of the rates paid out to dentists offering services through the Denti-Cal program. The report found that enrollment in the program has risen dramatically in the past five years, but low provider reimbursement rates have left the newly enrolled with limited options for oral health care.
Between 2009 and 2014, the number of children enrolled in Denti-Cal increased by 40%. (Note: Adult full-scope Denti-Cal services were cut in 2009.) Most of this increase occurred between 2011 and 2013 when the Healthy Families program transitioned into Medi-Cal. However, as enrollment skyrocketed, the number of Denti-Cal providers dropped by 14%.
The reason for the decreasing provider pool is clear: California’s reimbursement rates are some of the lowest in the country. California’s average reimbursement rates come in at less than one-third (28.3%) of the region’s commercial insurance rates. Compared to other states, California’s average rates are less than two-thirds of Texas’s (65.5%) and three-quarters of New York’s (75.4%).
A recent KPBS story discussed what California needs to do to increase provider participation:
Jenny Kattlove, programs director of The Children’s Partnership, a nonprofit advocacy group, said dentists who treat kids with Denti-Cal coverage take a financial hit.
“The state really needs to look at its priorities and set rates higher, so that it can attract enough quality providers,” Kattlove said.
State lawmakers recently reversed a ten percent Denti-Cal pay cut that took effect in 2013. But the California Dental Association says if the state wants to get more dentists in the program, it needs to increase Denti-Cal rates.
CPEHN and other advocates have been pushing for increased provider rates in Denti-Cal (and Medi-Cal as a whole) in budget debates over the last several years. We have also advocated for the restoration of full-scope dental benefits for adults. For more information on our budget advocacy efforts, please visit our Policy Center.