BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: SB 377
S
AUTHOR: Ortiz
B
AMENDED: September 2, 2005
HEARING DATE: September 8, 2005
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FISCAL: Appropriations / URGENCY
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CONSULTANT:
Vazquez / ak
~~ 29.10: Concurrence of Assembly Amendments ~~
SUBJECT
Medi-Cal: dental services
SUMMARY
This bill requires the Department of Health Services to
inform Denti-Cal and other Medi-Cal providers that
prevention and treatment of dental and periodontal disease
is a covered benefit for all pregnant beneficiaries.
ABSTRACT
Existing law:
1.Existing law establishes the Medi-Cal program,
administered by the Department of Health Services (DHS),
that provides certain benefits to qualified recipients.
Certain dental services are covered Medi-Cal benefits.
This bill:
1.Makes findings and declarations related to appropriations
for prevention and treatment services for dental and
periodontal disease during pregnancy.
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2.States legislative intent to reaffirm the Legislature's
commitment to the provision of non-emergency Medi-Cal
benefits for those services.
3.Requires DHS to immediately implement the provision of
prevention and treatment services for dental and
periodontal disease for all pregnant beneficiaries by
informing Denti-Cal and other Medi-Cal providers through
a provider bulletin or bulletins that such services are
included Medi-Cal benefits for pregnant beneficiaries.
4.Requires DHS to adopt regulations to implement the
provisions of this bill by January 1, 2008. Requires
that the implementation of this bill not be delayed
pending the adoption of those regulations.
5.States that this act is an urgency statute necessary for
Medi-Cal beneficiaries to receive needed prevention and
treatment benefits for dental and periodontal disease
during pregnancy, so as to prevent premature deliveries
and low birth weights.
FISCAL IMPACT
The Assembly Appropriations Committee estimates General
Fund costs in 2005-06 of approximately $340,000. The
2005-06 Budget Act assumed coverage of periodontal services
for Medi-Cal beneficiaries receiving pregnancy-only
services beginning in May 2006 through regulation. In
2006-07 and thereafter, the additional cost of dental
benefits through this bill and the regulations scheduled
for adoption would likely be offset by savings from the
reduction in the delivery of preterm and low-birth weight
babies. In previous budget years, the state has assumed
the addition of this dental benefit for pregnant women
would result in savings of $1.11 to $1.35 on neonatal
intensive care services for every $1 spent on dental
services for pregnant women.
Inclusion of these individuals is consistent with existing
DHS policy since the current Medi-Cal budget estimate
includes providing services for these individuals.
However, services cannot be provided until regulations are
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adopted by DHS. This bill would permit services to be
provided on an expedited basis.
Background
According to the author, recent medical studies show that
basic dental cleanings and treatment during pregnancy
reduce the likelihood of pre-term delivery and low birth
weight infants, the leading cause of infant morbidity and
mortality. In order to improve medical outcomes, in the
2001-02 budget, the Legislature appropriated funds for some
limited non-emergency dental benefits for pregnant women
who receive Medi-Cal for pregnancy-related services only.
Benefits for women in these initial four Aid Codes were
implemented in November 2002. Implementation of the
initial four Aid Codes was done by way of a provider
bulletin, which is in effect to this day.
SB 377 would require DHS to immediately implement several
basic Denti-Cal services for pregnant women in Medi-Cal's
pregnancy-related care programs by using a provider
bulletin or bulletins. This bill would also expand
eligibility to 14 additional Aid Codes, which would expand
services to additional populations, and DHS estimates this
to be approximately 42,600 individuals. According to
Assembly analyses, DHS estimates show that for every dollar
spent on dental cleanings and basic treatment for pregnant
women, over a dollar, ranging from $1.11 to $1.35, is saved
by avoiding neonatal intensive care services for preemies.
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Arguments in support
The sponsor and proponents state that SB 377 results in a
net savings to the state. Most importantly, SB 377 would
promote maternal health and help to save newborns from
lifelong disabilities and even death. "The Legislature has
wisely provided these basic dental benefits to all pregnant
women in Medi-Cal since 2001. Unfortunately, the benefits
are not reaching all eligible women because of
administrative delays in the implementation." Proponents
argue that SB 377 would simply cut through the red tape and
require DHS to implement these important benefits for
pregnant women immediately, pending the adoption of formal
regulations.
The research shows that maternal gum disease during
pregnancy can be as harmful to the newborn as smoking or
alcohol use during pregnancy, since the infection from gum
disease can spread throughout the body. Routine dental
cleanings to prevent gum disease and treatment to halt gum
disease after it develops help to avoid adverse birth
outcomes for both mothers and babies. According to the
March of Dimes, premature births have soared to become the
number one obstetric problem in the United States.
POSITIONS
Support: Maternal and Child Health Access (sponsor)
California Dental Association
California District of the American Academy of
Pediatrics
California Maternal, Child and Adolescent Health
Directors
Children's Defense Fund
Coastal Communities Hospital's Department of
Maternal Child Health
Eisner Pediatric & Family Medical Center
Human Options
Perinatal Advisory Council: Leadership, Advocacy
and Consultation
South Bay Perinatal Access Project
Western Center on Law and Poverty
4 Individuals
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Oppose:None on file.
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