BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1051 (Maienschein) - Denti-Cal program: reimbursement rates
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: August 2, 2016 |Policy Vote: PUB. S. 6 - 0, |
| | HEALTH 8 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 8, 2016 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1051 would require the Department of Health Care
Services to increase provider reimbursement rates for the 15
most common dental services provided in the Denti-Cal program to
average commercial rates.
Fiscal
Impact:
One-time costs in the millions to revise program requirements
and to process additional enrollment of Denti-Cal providers
under the bill (General Fund and federal funds).
Projected ongoing costs of $535 million per year due to
increased costs for services currently being provided in
Denti-Cal (General Fund and federal funds). Based on existing
utilization of the impacted Denti-Cal services, current
Medi-Cal rates, and survey data on commercial rates, the cost
to increase Medi-Cal rates to those found in the commercial
market would be $525 million per year. Note that those costs
reflect the cost increase at current utilization levels.
AB 1051 (Maienschein) Page 1 of
?
Projected ongoing costs in the hundreds of millions per year
due to increased utilization of Denti-Cal services (General
Fund and federal funds). Utilization rates of Denti-Cal
services are relatively low. There is consensus that low
reimbursement rates discourage dentists from participating in
the program, limiting access to services. By raising Denti-Cal
rates substantially, the bill is likely to encourage dentists
to see additional Denti-Cal patients. For every 10% increase
in utilization, annual costs would be about $90 million.
Unknown potential cost-savings due to increased use of
preventative dental services (General Fund and federal funds).
Regular dental care, particularly for children, is likely to
prevent dental conditions, such as cavities, from becoming
more serious health problems that require more costly
interventions later. To the extent that the bill results in
increased utilization of preventative dental services in
Denti-Cal, there are likely to be reduced costs for more
serious dental services. Given the very high costs that would
be incurred under the bill, it does not seem likely that
future cost savings would offset those increased costs.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Medi-Cal coverage includes full dental coverage for children and
limited dental coverage for adults. (Adult coverage had been
eliminated from the program in 2009 but was partially restored
in 2013.) Dental services in Medi-Cal, referred to as Denti-Cal,
are provided through the fee-for-service system in most of the
state. Denti-Cal services are provided through dental managed
care in Sacramento and Los Angeles Counties (enrollment in
dental managed care is mandatory in Sacramento but optional in
Los Angeles).
AB 1051 (Maienschein) Page 2 of
?
Recent analyses of the Denti-Cal program by the Bureau of State
Audits and the Little Hoover Commission have found low levels of
utilization (particularly by children), low provider
reimbursement rates, and a complicated system for providers to
navigate. Estimates of the annual usage vary. According to the
Little Hoover Commission, in 2014 only 26% of eligible adults
saw a dentist. According to the Department, 52% of eligible
children saw a dentist in 2015. According to the federal
government, 38% of eligible children saw a dentist in 2014.
Proposed Law:
AB 1051 would require the Department of Health Care Services
to increase provider reimbursement rates for the 15 most common
dental services provided in the Denti-Cal program to average
commercial rates.
Related
Legislation:
AB 2207 (Wood) would enact an number of changes to the
operation of the Denti-Cal program, relating to provider
enrollment, program monitoring, and reporting. That bill is
pending on this committee's Suspense File.
SB 1098 (Canella) would establish a Denti-Cal Advisory Group
within the Department of Health Care Services to study and
oversee the policies and priorities of the Denti-Cal program.
That bill is pending in the Assembly.
Staff
Comments: As noted above, the reimbursement rates paid by the
Denti-Cal program are significantly below average rates paid by
commercial dental coverage. According to data provided by the
Department of Health Care Services, commercial rates for common
dental procedures range from 200% to 400% of the rates paid by
Denti-Cal.
-- END --
AB 1051 (Maienschein) Page 3 of
?