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DENTI-CAL - Dental Services are currently provided as one of the many benefits under the Medi-Cal program.

The dental portion of the Medi-Cal program is called Medi-Cal Dental Services. This includes the fee-for-service program (known as Denti-Cal), as well as dental managed care programs.

Dental managed care operates on a voluntary basis in LA, Riverside, and San Bernardino counties, serving approximately 200,000 beneficiaries. The agreement with the Department of Health Care Services is to allow this voluntary participation up to a maximum of 350,000 beneficiaries.

States are required to cover children's dentistry in their Medicaid programs, but coverage for adults is optional. While the federal government does not require it, California provides dental services to its adult Medicaid population (Medi-Cal Dental Services).

However, as this coverage is commonly seen as optional, state budget constraints are consistently met with proposals to eliminate adult dental services, both in California and nationally. As of 2005, 26 states have chosen to either eliminate these services entirely or reduce them to emergency services only. Another 17 states list their services as “limited,” which is often so limited as to provide virtually no real options for care.

Dental services provided to individuals 21 years or older shall be limited to $1800 per beneficiary in any calendar year, commencing on January 1, 2006.

The battle to retain adult Denti-Cal services in California has been fought repeatedly for more than a decade. The focus on oral health produced by the Surgeon General’s report increased awareness of oral health as an indisputable part of general health and supports CDA’s position that its time to end the “optional” status of adult Medicaid dental services and make these services an integral part of the overall health care Medicaid recipients receive. When this change occurs at the federal level, the assurance of federal matching funds will make it that much easier and smarter for California to continue to offer these services to its adult Denti-Cal population.

Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid program. For persons enrolled in both programs, any services that are covered by Medicare are paid before any payments are made by the Medicaid program, as Medicaid is always the “payer of last resort.”

Denti-cal no. 646