Amended in Senate August 2, 2016

Amended in Senate May 3, 2016

Amended in Senate July 15, 2015

Amended in Assembly May 4, 2015

Amended in Assembly April 20, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1051

Introduced by Assembly Member Maienschein

(Principal coauthors: Assembly Members Lackey, Steinorth, and Waldron)

(Principal coauthor: Senator Nielsen)

(Coauthors: Assembly Members Bigelow, Chang, Chávez, Dahle, Gallagher, Jones, Kim, Linder, Mathis, Mayes, Olsen, and Wilk)

(Coauthors: Senators Anderson, Bates, Berryhill, Cannella, Fuller, Huff, Nguyen, Stone, and Vidak)

February 26, 2015

An act relating to begin delete Medi-Cal, and making an appropriation therefor. end delete begin insert Medi-Cal. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1051, as amended, Maienschein. Denti-Cal begin delete program. end delete begin insert program: reimbursement rates. end insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits provided under the Medi-Cal program, which includes certain dental services that are referred to as Denti-Cal.

This bill would begin delete appropriate $200,000,000 from the General Fund to the State Department of Health Care Services for the Denti-Cal program. The bill would end delete require the begin delete department end delete begin insert State Department of Health Care Services end insert to begin delete allocate these funds to, among other things, increase funding for preventative care and case management services, as appropriate, to achieve significant long-term cost savings, increased provider participation, and increased beneficiary utilization under the Denti-Cal program. end delete begin insert increase Denti-Cal provider reimbursement rates for the 15 most common prevention, treatment, and oral evaluation services to the regional average commercial rates, effective January 1, 2017. end insert

Vote:  begin delete ²⁄₃ end delete begin insert majority end insert . Appropriation:  begin delete yes end delete begin insert no end insert . Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) California’s Medicaid dental program, Denti-Cal, is charged
with providing an adequate level of dental coverage to 13 million
low-income Californians, including five million children.

(b) Dental care, particularly preventative care, can have
significant long-term impacts. Tooth decay and disease are
associated with pregnancy risks, diabetes, and respiratory and heart
disease. Additionally, a lack of access to dental care among
children can result in missed school days, and ultimately poorer
academic performance.

(c) Denti-Cal, as currently implemented and funded, is a failure.
Just 37.8 percent of California’s five million Denti-Cal-eligible
children saw a dentist in the 2014 calendar year.

(d) The Milton Marks “Little Hoover” Commission on California
State Government Organization and Efficiency and the California
State Auditor both note these low utilization rates, which stem
from a lack of providers and an uneven distribution of those
providers that do participate in the Denti-Cal program. Five
counties have no providers, and 14 counties only have providers
that are not accepting new patients.

(e) The lack of providers is partly a result of low reimbursement
rates, which are typically one-third to one-half of the national
average for common procedures.

SEC. 2.  

(a)  begin delete The sum of two hundred million dollars
($200,000,000) is hereby appropriated from the General Fund to
the State Department of Health Care Services for the Denti-Cal
program. The end delete begin insert It is the end insert intent of the Legislature begin delete is end delete to attract and
retain more begin insert Denti-Cal end insert providers, with an emphasis on underserved
areas, and to increase utilization of the program.

(b)  begin delete The end delete begin insert Effective January 1, 2017, the end insert State Department of
Health Care Services shall begin delete allocate the funds appropriated in
subdivision (a), as appropriate, to accomplish both of the following: end delete

begin delete (1) end delete begin delete   end delete begin delete Increase end delete begin insert increase Denti-Cal provider end insert reimbursement rates
for the 15 most common prevention, treatment, and oral evaluation
services to the begin delete Medicaid national average. end delete begin insert regional average
commercial rates. end insert

begin delete

(2) Increase funding for preventative care and case management
services, as appropriate, to achieve significant long-term cost
savings, increased provider participation, and increased beneficiary
utilization under the program.

end delete begin delete

(c) Any funds remaining after the allocation specified in
subdivision (b) shall be allocated to other uses that further the
intent of the Legislature, as described in subdivision (a), including,
but not limited to, increasing additional reimbursement rates to
the national average.

end delete