Dental Trends

Higher Denti-Cal reimbursement rates in 2018?

December 21, 2016

California lawmakers have introduced a bill in the State Assembly to boost reimbursement rates for dentists participating in Denti-Cal, the state’s Medicaid program for dental care.

A recent Kaiser Health News piece explains that California’s funding for dental care ranks very low compared to other states. These below-average reimbursement rates give dentists little incentive to take on Denti-Cal patients, and those that do are overwhelmed with volume, making it difficult to offer quality care to everyone.

To put things in perspective, the national average reimbursement payment for an oral exam is $45.61; California dentists get only $15. This challenging math discourages dentists from accepting Denti-Cal patients, which in turn adds to the patient load of those who do participate.

A report by the Little Hoover Commission (an independent state oversight agency) calls the situation in California a “silent, hidden epidemic of tooth decay and disease” affecting “a third of the state’s population and half of its children.” The program’s “dreadful” reimbursement rates have left new patients in 11 of California’s 58 counties without a single Denti-cal dentist to visit.

The proposed bill would increase the Denti-Cal reimbursement rate in 2018 for the 15 most common dental services, including cleanings and fillings. Although the draft legislation doesn’t name a specific funding source for the increase, its sponsors have mentioned a recent statewide cigarette tax hike as a possible candidate. The tax hike is expected to bring in $1 billion of additional annual revenue for the state.

Any bump in reimbursement rates would be welcome news to our many Denticon practices in California that have struggled with Denti-Cal in the past.