What Dental Benefits Are Covered Under Denti-Cal?

What Dental Benefits Are Covered Under Denti-Cal?

Discover which dental benefits are included under California’s Medi-Cal program: Denti-Cal.

Although often overlooked or given secondary status, dental and oral health are major factors in our overall health and wellness. In addition to cavities and periodontitis, poor dental health can contribute to very serious medical issues, such as cardiovascular disease, dementia, respiratory infections, and diabetic complications. So it’s important that your clients take good care of their teeth and gums and also take advantage of dental health benefits offered through Denti-Cal whenever possible.

What Services Are Offered As Part of Denti-Cal?

California’s Medicaid program, known as Medi-Cal, is financed by the State of California and the federal government, and it is a public health insurance program providing health care services for low-income families, pregnant women, and individuals with disabilities. One of the benefits offered for children and adults is dental care through the Denti-Cal program.

Denti-Cal services include:

  • Cleanings: Dental cleanings help prevent cavities, stop tooth loss, and lessen a person’s chances of developing heart disease or suffering from a stroke. Routine exams that occur during cleanings can help spot potentially life-threatening diseases and initiate early treatment programs.
  • Fillings: Dental fillings are outpatient surgical procedures in which small holes in the teeth that have been created as a result of tooth decay are filled in to prevent further damage. If left untreated, cavities could lead to a root canal or even the loss of a tooth.
  • Fluoride Treatments: Fluoride is a mineral that is naturally added to and lost from tooth enamel every day in opposing processes known as mineralization and demineralization. Fluoride treatments make tooth enamel more resistant to plaque and sugar and helps reverse early tooth decay.
  • Diagnostic Imaging: The most common form of dental X-rays (radiographs) are intraoral X-rays, and they allow dentists to find cavities, examine roots, and diagnose periodontal disease.
  • Root Canals: If a tooth has been physically displaced or a nerve has become exposed due to tooth decay, a root canal is likely necessary. This procedure strengthens the structural integrity of the tooth and keeps it functioning properly.
  • Prefabricated Crowns: Crowns are occasionally needed for a variety of reasons: to stabilize weak teeth, to repair a broken or compromised tooth, to hold a dental bridge in place, or even for strictly cosmetic reasons. It’s a fairly simple procedure in which a cap is placed over the tooth and cemented in place to cover the visible portion of a tooth.
  • Full Dentures: Individuals who have lost some or all of their teeth have the option of using false teeth for both practical and cosmetic reasons.
     

Why Aren’t More Californians Taking Advantage of Denti-Cal?

Unfortunately, Denti-Cal has become notorious for bureaucratic inefficiencies and very low reimbursement rates. Despite the fact that one third of California’s entire population (and more than half of the state’s children) are eligible for the program, only 23% of eligible adults visited a dentist in 2013-14, and that number isn’t much better for eligible children at just 44%.

So why aren’t more Californians taking advantage of Denti-Cal? As usual, it’s a question of money. Specifically, the program is subject to a lack of funding. For instance, California’s average reimbursement rates for 10 of the most common dental procedures was $21.60 in 2012, which was just 35% of the national average. Because of this, many dentists actually lose money when they treat Denti-Cal patients.

Not only is the program sometimes cost-prohibitive for practitioners, but it’s also wrapped in red tape, making it extremely inconvenient to implement. Getting pre-authorizations for even the most basic procedures can be a major source of frustration, and an ineffective billing system can make it difficult to actually recoup the meager sums that dentists are reimbursed.

However, a recent proposal in the California State House might help pave the way for healthier smiles throughout our state. Legislation was introduced in late 2016 that proposes appropriating revenue from California’s newly approved tobacco tax to increase pay for dentists that participate in Denti-Cal. As part of the pending legislation, reimbursement rates for the 15 most common dental treatment and prevention services would be adjusted to match average commercial rates. If the proposal passes, it will go into effect in 2018 and double the average reimbursement rate for common procedures, such as regular cleanings and cavity fillings.

Reference

Gorn, D. (2016, April 6). California’s dental safety net fails most clients, report says. NPR. Retrieved from http://www.npr.org/sections/health-shots/2016/04/06/473122240/californias-dental-safety-net-fails-most-clients-report-says