BILL ANALYSIS Ó
AB 2108
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2108
(Waldron) - As Amended March 16, 2016
SUBJECT: Medi-Cal: adult dental services.
SUMMARY: Requires the Department of Health Care Services
(DHCS), on or before January 1, 2018, to submit a report to the
Legislature on the cost and feasibility of restoring full adult
dental services as a covered benefit under the Medi-Cal Program.
Sunsets this bill on January 1, 2019.
EXISTING LAW:
1)Establishes the federal Medicaid Program (Medi-Cal in
California), administered by DHCS, to provide comprehensive
health care services and long-term care to pregnant women,
children, and people who are aged, blind, and disabled.
2)Establishes the Medi-Cal Dental Program (Denti-Cal) which
covers specified dental benefits for children and adults.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
AB 2108
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COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill is
necessary because Medi-Cal does not provide adequate dental
services for adults. The author states that this bill can
tremendously help legislative budget discussions by requiring
a report to the Legislature on the costs associated with
restoring full adult dental services as a covered benefit
under Denti-Cal.
2)BACKGROUND. States are federally required to provide dental
benefits to children covered by Medicaid and the Children's
Health Insurance Program. Denti-Cal is the Medicaid program
that provides comprehensive dental care to pediatric and
pregnant Medi-Cal beneficiaries and limited emergency services
to adult beneficiaries. While Medicaid covers dental services
for all child enrollees as part of a comprehensive set of
benefits, referred to as the Early and Periodic Screening,
Diagnostic and Treatment benefit, states may choose whether to
provide dental benefits for adults. Minimum federal
requirements for pediatric dental Medicaid programs include
relief of pain and infections, restoration of teeth, and
maintenance of dental health. For children in Medi-Cal,
dental care is provided on a fee-for-service (FFS) basis in
all counties, with Sacramento and Los Angeles Counties also
offering services through dental managed care (DMC) plans.
For more than 40 years Medicaid-enrolled Californians of any age
were eligible for basic diagnostic, preventive, restorative,
and emergency dental procedures provided by participating
dentists through Denti-Cal. In 2007, Denti-Cal provided
comprehensive oral health care to more than eight million
people. However, from July 2009 to May 2014, California
eliminated funding for most adult non-emergency Denti-Cal
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benefits, effectively eliminating California's oral health
safety-net. A partial restoration of benefits, primarily
diagnostic and preventative services, was enacted in the 2013
Budget Act and became effective May 1, 2014.
ABX3 5 (Evans) Chapter 20, Statutes of 2009-10 Third
Extraordinary Session, eliminated optional dental benefits for
adults, such as preventative cleanings, to Medi-Cal
beneficiaries age 21 and older with some exceptions effective
July 1, 2009. These exceptions include: a) pregnant women;
b) beneficiaries living in skilled nursing facilities and
intermediate care facilities; and, c) developmentally disabled
beneficiaries due to requirements under the Lanterman Act.
Beneficiaries continue to receive certain medical and surgical
dental services, such as oral surgery, that are federally
required adult dental services. In 2006-07, about 932,000
adult beneficiaries accessed dental services. AB 82
(Committee on Budget), Chapter 23, Statutes of 2013, restored,
in part, Medi-Cal Adult Dental Benefits effective May 1, 2014,
for $55.3 million ($16.9 million General Fund (GF)). This
partial restoration includes preventive/diagnostic services,
restoration services (amalgams, composite and stainless steel
crowns), and full mouth dentures.
According to the DHCS, the cost to restore full adult dental
services is as follows:
SUMMARY: COST TO RESTORE 'FULL' DENTAL BENEFITS
----------------------------------------------------------
| Fiscal Year 2016-17 |
| |
----------------------------------------------------------
|----------+----------+---------+-+-------------+------------|
| Total | Federal | GF | | FFS Total | DMC Total |
| | | | | | |
| Fund | Fund | | | Fund | Fund |
| | | | | | |
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| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
|----------+----------+---------+-+-------------+------------|
|$263,094,3|$165,021,2|$98,073,1| | $234,498,729|$28,595,658 |
| | | | | | |
| 88 | 20 | 68 | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
------------------------------------------------------------
Source: DHCS November 2015 Estimate
3)RELATED LEGISLATION:
a) AB 2207 (Wood) Makes changes to the Medi-Cal dental
provider enrollment and disenrollment process, increases
access and utilization oversight responsibility of the DHCS
over Denti-Cal, and aligns Denti-Cal FFS and DMC annual and
quarterly data reporting requirements. AB 2207 is pending
in Assembly Health Committee.
b) AB 2834 (Low) adds to the components of the dental
health program the development and maintenance of a data
collection and reporting system to monitor the dental
disease experience and unmet dental need in California.
4)POLICY COMMENT. This bill requires DHCS to submit a report on
the cost and feasibility of restoring full dental services
which is more appropriately addressed through the budget
process. As such, the Committee may suggest to the author to
submit this request through the budget process instead.
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REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file
Analysis Prepared by:Rosielyn Pulmano / HEALTH / (916) 319-2097