BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1098|
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UNFINISHED BUSINESS
Bill No: SB 1098
Author: Cannella (R)
Amended: 8/15/16
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/20/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SENATE FLOOR: 38-0, 6/2/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone,
Vidak, Wieckowski, Wolk
NO VOTE RECORDED: Liu, Runner
ASSEMBLY FLOOR: 79-0, 8/24/16 - See last page for vote
SUBJECT: Medi-Cal: dental services: advisory group
SOURCE: Author
DIGEST: This bill requires the Department of Health Care
Services (DHCS) to report to the Legislature on progress towards
the goal of raising the Denti-Cal utilization rate among
eligible child beneficiaries to 60% or greater and to identify a
date by which DHCS projects this utilization goal will be met.
Sunsets the provisions of this bill on January, 1, 2021.
SB 1098
Page 2
Assembly Amendments delete provisions establishing in DHCS the
13-member Denti-Cal Advisory Group (Advisory Group), and
specifying the duties of the Advisory Group, and instead insert
the above-described reporting requirement.
ANALYSIS:
Existing law:
1)Establishes the Medi-Cal program, which is administered by the
DHCS, under which qualified low-income individuals receive
health care services, including certain dental services, as
specified.
2)Requires the Department of Public Health (DPH) to maintain a
dental program including, but not limited to, the following:
a) Development of comprehensive dental health plans within
the framework of the State Plan for Health to maximize
utilization of all resources;
b) Provide the consultation necessary to coordinate
federal, state, county, and city agency programs concerned
with dental health;
c) Encourage, support, and augment the efforts of city and
county health departments in the implementation of a dental
health component in their program plans;
d) Provide evaluation of these programs in terms of
preventive services; and,
e) Provide consultation and program information to the
health professions, health professional educational
institutions, and volunteer agencies.
3)Requires the director of DPH to appoint a California-licensed
dentist to administer the dental program in 2) above.
This bill:
1)Requires DHCS, by October 1, 2017, to report to the
Legislature on progress towards the goal of raising the
Denti-Cal utilization rate among eligible child beneficiaries
to 60 percent or greater and identify a date by which DHCS
projects this utilization goal will be met.
SB 1098
Page 3
2)Permits DHCS to include in the report any recommendations for
legislative consideration that would assist DHCS in meeting
the goal by the specified date, and, if applicable, requires
DHCS to engage relevant stakeholders in the development of
those recommendations.
3)Sunsets the provisions of this bill on January 1, 2021.
Comments
1)Author's statement. According to the author, in a state audit
of DHCS' Denti-Cal Program released in 2014, the auditor
concluded that "DHCS' information shortcomings and ineffective
actions are putting children enrolled in Medi-Cal at higher
risk of dental disease." It is unacceptable that a program
established to provide the most vulnerable population of
children with oral health services is placing those children
at risk of dental disease. The same report also highlights the
program's low children utilization rates. The "program's
statewide utilization rates for child beneficiaries was 41.4%
in 2013 accounting for fee for service, managed care delivery
models, and from centers and clinics. In a report entitled
"Fixing Denti-Cal," released in April 2016, the Little Hoover
Commission recommends that the Legislature set a utilization
target rate. This bill sets a target rate of 60% or greater,
as is the case in approximately 20 percent of U.S. states.
DHCS must also identify a date by which it projects this
utilization goal will be met, and it would be authorized to
include in the report recommendations for legislative
consideration that would assist DHCS to meet the goal by the
specified date.
2)Medi-Cal has two different models for delivering dental
services. The Medi-Cal Program is administered by DHCS and
covers dental services for children under age 21 and a more
limited benefit for adults. Adult dental coverage was
eliminated in 2009 in AB 5 (Committee on Budget, Chapter 20,
Statutes of 2009), which also eliminated other optional
benefits for adults that had been covered under Medi-Cal. A
more limited adult dental benefit was restored in AB 82
(Budget Committee, Chapter 23, Statutes of 2013), the 2013-14
SB 1098
Page 4
budget health trailer bill. Medi-Cal uses two different models
for delivering dental services to children: fee-for-service
(FFS) and Dental Managed Care in two counties.
3)Denti-Cal utilization. Denti-Cal utilization is low with
different estimates for different time frames. According to
the Little Hoover Commission report, only 26% of eligible
California adults with fee-for-service Denti-Cal coverage saw
a dentist in 2014, according to February 2016 DHCS data. DHCS
stated that 51.8% of children 20 and under with Denti-Cal
fee-for-service coverage had a dental visit from October 2014
through September 2015. In December 2015, the Centers for
Medicare and Medicaid Services (CMS), in approving the
California Medi-Cal 2020 waiver, cited a figure of 37.8% of
children 20 and under making a dental visit during the
calendar year 2014. In December 2014, the California State
Auditor cited CMS data to report that only 44% of California's
5.1 million Denti-Cal-eligible children aged 20 and under saw
a dentist from October 2012 through September 2013.
DHCS currently has a small workgroup effort regarding
implementation of the Dental Transformation Initiative under
the Medi-Cal 2020 Waiver. The purpose of this workgroup is to
collaborate with DHCS on the planning and implementation
efforts that are needed to ensure the success of the dental
component of the waiver.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee:
According to the Assembly Appropriations Committee, to the
extent this bill results in additional utilization of dental
services based on the specific utilization goal of 60%, unknown,
potentially significant costs to the Denti-Cal program, as well
as potential cost avoidance through prevention of more severe
dental problems by improving access to dental preventive care
(General Fund/federal). The net effect is unknown.
SB 1098
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SUPPORT: (Verified8/24/16)
California Dental Association
California Dental Hygienists' Association
California Health + Advocates
California Pan-Ethnic Health Network
Little Hoover Commission
OPPOSITION: (Verified8/24/16)
None received
ARGUMENTS IN SUPPORT: California Health+ Advocates (CH+A)
writes in support that California's community clinics and health
centers (CCHC), provide approximately one-third of Medi-Cal
dental care to adults and children in California, and thus
understand the value of oral health. CH+A states that the
Little Hoover Commission's report, "Fixing Denti-Cal," made
clear the need for immediate action to improve Denti-Cal
policies and priorities with the aim of increasing timely access
to quality oral health services. CH+A states that it supports
efforts to document improvements to access and continue
legislative engagement on Denti-Cal.
ASSEMBLY FLOOR: 79-0, 8/24/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Dodd, Eggman, Frazier, Beth Gaines,
Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger
Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey,
Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes,
McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
SB 1098
Page 6
NO VOTE RECORDED: Daly
Prepared by:Scott Bain / HEALTH / (916) 651-4111
8/26/16 8:51:16
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