BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1098 (Cannella) - Medi-Cal: dental services: advisory group
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: April 21, 2016 |Policy Vote: HEALTH 9 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: May 9, 2016 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 1098 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 and
to provide assistance and advice to the Department, the
Legislature, and the Governor.
Fiscal
Impact:
Ongoing costs, likely between $50,000 and $150,000 per year to
provide staff support to the Advisory Group (General Fund and
federal funds). It is likely that the Advisory Group will need
staff support from the Department to assist it with gathering
information, interpreting data and program requirements, and
formulating recommendations.
Unknown additional costs to provide Denti-Cal benefits to
children, to the extent that the Advisory Group is successful
in improving the utilization of Denti-Cal services (General
Fund and federal funds). Currently, the state spends about
$1.2 billion per year on Denti-Cal for adults and children.
SB 1098 (Cannella) Page 1 of
?
Estimates of the utilization rate for children vary, but are
all well below the goal set in the bill of 60% annual
utilization. On its own, the Advisory Group would not have the
authority to raise reimbursement rates or streamline program
requirements. However, to the extent that the Advisory Group
is able to work with the Department to take actions that
improve access to services, there will be increased
utilization costs. For every 5% increase in annual utilization
by children, the cost would be about $35 million per year.
Unknown potential cost-savings due to increased use of
preventative dental services (General Fund and federal funds).
Regular dental care 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 by children in Medi-Cal, there
are likely to be reduced costs for more serious dental
services. Whether those avoided costs are greater than the
cost of providing greater access to preventative services is
unknown.
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 not in Los Angeles).
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
SB 1098 (Cannella) Page 2 of
?
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, in 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:
SB 1098 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 and to provide
assistance and advice to the Department, the Legislature and the
Governor.
Specific provisions of the bill would:
Establish a Dental Advisory Group within the Department;
Establish the duties of the Advisory Group to include
studying and overseeing the policies and priorities of
Denti-Cal with the goal of raising the utilization rate for
eligible children to 60% or greater and to provide
assistance and advice to the Department, the Legislature,
and the Governor regarding the program;
Establish the membership of the Advisory Group;
Prohibit compensation to the members of the Advisory
Group, except for per diems and reimbursement for expenses.
Related
Legislation: AB 2207 (Wood) would require the Department of
Health Care Services to undertake specified activities to
improve the Denti-Cal program. That bill is pending in the
Assembly Appropriations Committee.
Staff
Comments: There have been several actions taken recently to
improve the provision of dental services in Medi-Cal. In 2015,
the state eliminated the 10% rate reduction for dental services
that was enacted in 2009 (at a cost of $60 million per year). In
addition, the recently approved Medi-Cal 2020 waiver includes
$750 million over five years for incentive payments to increase
Denti-Cal utilization and improve outcomes for children.
SB 1098 (Cannella) Page 3 of
?
-- END --