Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals, the availability of federal financial participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.

This bill would expand the above-described dental benefits, for beneficiaries 21 years of age or older, to at least 2 cleanings and at least 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria. The bill would, for purposes of these provisions, include an individuals inability to maintain daily oral hygiene habits, susceptibility to oral health disease or decay, preoperative dental care, or as required by other specified provisions of law, in the definition of medically necessary, and require the department to update the Medi-Cal Dental Manual of Criteria to conform with this inclusion.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and approvals, the availability of federal financial participation and participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.

This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age. expand the above-described dental benefits, for beneficiaries 21 years of age or older, to 2 cleanings and 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and the availability of federal financial participation and funding in the annual Budget Act.

This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age.

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2701 (Villapudua) - Medi-Cal: dental cleanings and examinations

Bill Summary:

AB 2701 would expand the Medi-Cal dental benefit for examinations and cleanings, as specified.

Fiscal Impact:

Unknown ongoing costs in the Medi-Cal program to provide the expanded dental benefits (General Fund and federal funds).

Background:

The Medi-Cal program provides health coverage for eligible low-income individuals. Dental services for children are a mandatory benefit of the federal Medicaid program that participating states must provide, while adult dental services are an optional benefit that states may provide. Regarding dental examinations and dental cleanings, current state law requires the Medi-Cal program to cover, to the extent funds are made available in the annual Budget Act:

• One dental preventive cleaning per year and one initial dental examination by a dentist for Medi-Cal recipients 21 years of age or older.
• Two dental preventive cleanings per year and two periodic dental examinations per year for Medi-Cal recipients under 21 years of age.

Under the Medi-Cal Dental Manual of Criteria, the Medi-Cal program does allow for additional preventive cleanings when medical necessity is justified due to a physical limitation or an oral condition that prevents daily oral hygiene, if prior authorization is obtained.

Proposed Law:

AB 2701 would add as a Medi-Cal benefit for recipients 21 year of age or older, when medically necessary, as defined:

• At least two preventive dental cleanings per year.
• At least two periodic dental examinations per year.

Related Legislation:

SB 980 (Wahab) would expand the Medi-Cal dental benefit for implants. The bill is currently in the Assembly Appropriations Committee.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2701

SUBJECT: Medi-Cal: dental cleanings and examinations.

SUMMARY:

1. Allows Medi-Cal recipients 21 years of age or older to have a second dental preventive cleaning and dental exam per year when medically necessary, as defined in the Medi-Cal Dental Manual of Criteria, and to the extent funds are made available in the annual Budget Act for this purpose.

Existing law:

1. Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000 et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes benefits required under federal law and benefits provided at state option but for which federal financial participation through Medicaid is available, including specified dental benefits. [WIC §14132]
3. Covers one dental preventive cleaning per year and one initial dental examination by a dentist for Medi-Cal recipients 21 years of age or older, to the extent funds are made available in the annual Budget Act for this purpose. [WIC §14132.88]
4. Covers two dental preventive cleanings per year and two initial dental examinations by a dentist for Medi-Cal recipients under 21 years of age, to the extent funds are made available in the annual Budget Act for this purpose. [WIC §14132.88]

This bill: Allows Medi-Cal recipients 21 years of age or older to have a second dental preventive cleaning and dental exam per year when medically necessary, as defined in the Medi-Cal Dental Manual of Criteria, and to the extent funds are made available in the annual Budget Act for this purpose.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill would have annual costs of an unknown amount, potentially in the millions of dollars annually, to DHCS (General Fund, federal funds). Costs would likely be limited by the availability of Medi-Cal providers to provide the services required by this bill.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill will expand California’s Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21 and over, when medically necessary. With a second cleaning and exam, dentists can detect any oral health complications, prevent tooth loss, and even detect early heart problems as several reports suggest poor dental health is linked to diabetes, dementia, and cardiovascular diseases. A second cleaning and exam is essential to maintain good oral health and overall health. 
2. Medi-Cal coverage of dental services. Dental services for children are a mandatory benefit of the Medicaid program that participating states must provide. Adult dental services are an optional state benefit. In times of a state budget shortfall, most dental services for adults have been cut from California’s Medicaid program (Medi-Cal). In 2009, all adult dental services excluding certain surgical services that are also considered physician services were cut. In 2014, a limited amount of services were restored, including preventive, diagnostic, restorative, anterior tooth endodontic treatment, complete dentures and complete denture reline/repair services. An unintended consequence of this partial restoration included a number of cases where Medi-Cal beneficiaries had healthy teeth removed to obtain full dentures, as partial dentures were not covered. In 2017, the remaining optional adult benefits were restored. In 2019, these benefits were again set to be suspended in 2021, absent a budget surplus. However, in 2021, this language was removed and the optional adult dental benefits have remained ever since.

Due to the optional nature of the adult dental benefit, coverage is often less for adults than it is for children. This bill would address one of those discrepancies: children can get two preventive cleanings and exams while adults can get only one. However, this bill limits the second cleaning and exam to those cases where such a cleaning and exam is medically necessary, as defined in the Medi-Cal Dental Manual of Criteria. The current manual does allow for additional preventive cleanings when medical necessity is justified due to a physical limitation or an oral condition that prevents daily oral hygiene, if prior authorization is obtained. This bill would still allow DHCS to determine the standard for medical necessity, though presumably for other reasons beyond the inability of the Medi-Cal recipient to brush their teeth.

1. Evidence-based standard for frequency of cleanings. While there is little dispute as to the value of preventive dental care, the number of necessary dental cleanings and exams per year is not as certain. Sponsors cite several studies regarding the effectiveness of preventive dental care in lowering subsequent non-preventive care and overall costs; however, those studies do not demonstrate that more preventive care has a correspondingly higher impact on non-preventive costs. According to a May 2024 article published in the Journal of the American Medical Association, evidence-based medicine has not had the same impact on dentistry that it has on medical care and the economic pressures of running a business often prevail in setting practice patterns. The article cited the regular six-month dental exams as an example of this. Nonetheless, while there may not currently be evidence to support six-month exams for all patients, there are patients who may have a medical necessity for more cleanings due to their oral health. However, DHCS’s current standard of medical necessity for additional cleanings in its Medi-Cal Dental Manual of Criteria that requires the recipient to be unable to perform daily oral hygiene is likely also too restrictive for these adults. Adults with gum disease or a history of frequent caries may need more frequent cleanings and exams to prevent disease, infection, or tooth loss. In these cases, an additional cleaning may prevent more costly and painful procedures later.
2. Related legislation. SB 980 (Wahab) adds coverage of dental implants under specified circumstances and codifies DHCS guidelines regarding the coverage of dental crowns. SB 980 is set for hearing on June 18, 2024 in the Assembly Health Committee.
3. Prior legislation. SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022) provided for the coverage of lab-processed crowns on posterior teeth when medically necessary to restore a posterior tooth back to normal function.

AB 133 (Committee on Budget, Chapter 143, Statutes of 2021) removed the requirement to suspend optional Medi-Cal benefits, including adult optional benefits, absent a state budget surplus.

SB 78 (Committee on Budget and Fiscal Review, Chapter 38, Statutes of 2019) suspended the restoration of optional Medi-Cal benefits including optional adult dental benefits on December 31, 2021 unless the state budget had a surplus.

SB 97 (Committee on Budget and Fiscal Review, Chapter 52, Statutes of 2017) restored many Medi-Cal optional benefits including the remaining optional adult dental services.

AB 82 (Committee on Budget, Chapter 23, Statutes of 2013) partially restored some optional adult dental services in Medi-Cal.

AB X3-5 (Evans, Chapter 20, Statutes of 2009) eliminated certain Medi-Cal optional benefits, including most optional adult dental services, effective July 1, 2009.

1. Support. Sponsor the California Dental Association writes that despite recent investments in the Medi-Cal Dental Program, there continues to be holes in the Medi-Cal dental benefit, including that beneficiaries over the age of 21 are only permitted one cleaning and exam a year. This is contradictory to the standard of care, every six months, to ensure maximum preventive care against dental diseases. They cite to studies regarding the importance of preventive dental care and the connection between poor oral health and common diseases such as heart disease and diabetes.
2. Amendments. DHCS’s current standard for additional dental cleanings and exams is currently based on medical necessity but limits such cleanings to recipients unable to perform regular daily hygiene rather than consider other factors that might necessitate more frequent cleanings. DHCS also indicated that under a medical necessity standard additional cleanings and exams could also be approved. As such, the author and committee have agreed to the following amendments that would clarify that the standard for medical necessity should be revisited, while not inadvertently limiting those medically necessary cleanings and exams:

Sec. 1, §14132.88(a)

. . .

(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:

(A) At least Two dental prophylaxis cleanings per year.

(B) At least Two periodic dental examinations per year.

(3) For purposes of this section, “medically necessary” includes an individual’s inability to maintain daily oral hygiene habits, susceptibility to oral health disease or decay, preoperative dental care, or as otherwise required by section 14059.5.

(4) The Department shall update the Medi-Cal Dental Manual of Criteria in accordance with (3).

SUPPORT AND OPPOSITION:

Support: California Dental Association (sponsor)

Association of Regional Center Agencies

California Association of Orthodontists

California Dental Hygienists’ Association

California Pan-Ethnic Health Network

California Retired Teachers Association

County Health Executives Association of California

Dental Hygiene Board of California, California Department of Consumer Affairs

Educate. Advocate.

Justice in Aging

Western Center on Law & Poverty

Oppose: None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2701

Author:(Villapudua)

As Amended Ver:May 16, 2024

Majority vote

SUMMARY

Requires Medi-Cal dental coverage, when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, of one additional prophlaxis cleaning and periodic dental exam per year (for a total of two per year) for adults age 21 and over.

Major Provisions

COMMENTS

1. Medicaid Requirements and State Optional Benefits. State Medicaid programs are required to provide certain benefits, and may choose to provide others at state option. All Medicaid programs cover 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. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state (in California, the American Academy of Pediatrics "Bright Futures" periodicity schedule of preventive health care).

Adult dental benefits are optional for states, meaning they have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. According to the Centers for Medicare and Medicaid Services, while most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum federal requirements for adult dental coverage.

1. Medi-Cal Adult Dental Coverage and Recent Adult Dental Changes. Medi-Cal currently covers one prophlaxis cleaning and periodic dental exam per year for adults over age 21.

Medi-Cal now covers a fairly comprehensive set of adult dental benefits at the state's option. However, along with a list of other optional Medi-Cal benefits, adult dental benefits were eliminated from Medi-Cal in 2009 as a budget cost-cutting solution. In May 2014, Medi-Cal adult dental benefits were partially restored. Adult dental benefits including additional exams, deep cleanings (scaling and root planing), laboratory crowns, partial dentures, and root canals in back teeth, were fully restored effective January 1, 2018.

Medi‑Cal will pay up to $1,800 in a year for covered dental services for adults, although there are exceptions for pregnancy and medically necessary services that exceed the $1,800 limit on a case by case basis.

According to the Author

This bill will expand California's Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21 and over when medically necessary. With a second cleaning and exam, the author asserts, dentists can detect any oral health complications, prevent tooth loss, and even detect early heart problems as several reports suggest poor dental health is linked to diabetes, dementia, and cardiovascular diseases. The author concludes a second cleaning and exam is essential to maintain good oral health and overall health. This bill is sponsored by the California Dental Association (CDA).

Arguments in Support

This bill is supported by consumer advocacy organizations, the County Health Executives Association of California (CHEAC), and Association of Regional Center Agencies, among others. According to CHEAC, the Centers for Disease Control and Prevention notes dental disease and tooth loss is disproportionately high among individuals who have lower incomes, and over 40% of low-income non-Hispanic Black adults have untreated tooth decay which impacts the quality of life and productivity of those individuals. CDA indicates the standard of care is a minimum of two exams and cleanings a year, or every six months, to ensure maximum preventive care against dental diseases.

Arguments in Opposition

There is no known opposition.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

Annual costs of an unknown amount, potentially in the millions of dollars annually, to the Department of Health Care Services (General Fund, federal funds). Costs would likely be limited by the availability of Medi-Cal providers to provide the services required by this bill.

According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

VOTES

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin, Villapudua

ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta

UPDATED

VERSION: May 16, 2024

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0003393

Date of Hearing: May 15, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2701

Author:(Villapudua) – As Introduced Ver:February 14, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires Medi-Cal dental coverage of two prophylaxis cleanings and two periodic dental exams (instead of one of each) per year for adults age 21 and over, subject to any necessary federal approvals, federal financial participation, and availability of funds in the annual budget act.

FISCAL EFFECT:

Annual costs of an unknown amount, potentially in the millions of dollars, to the Department of Health Care Services (General Fund, federal funds). Costs would likely be limited by the availability of Medi-Cal providers to provide the services required by this bill.

COMMENTS:

1. Purpose. The California Dental Association (CDA) is the sponsor of this bill. According to the author:

AB 2701 will expand California’s Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21+. With a second cleaning and exam, dentists can detect any oral health complications, prevent tooth loss, and even detect early heart problems as several reports suggest poor dental health is linked to diabetes, dementia, and cardiovascular diseases. A second cleaning and exam is essential to maintain good oral health and overall health.

1. Background. Dentists recommend twice yearly dental visits, and commercial dental insurance plans generally cover the services at this cadence. CDA indicates twice yearly is the standard of care. As noted in the Assembly Health Committee analysis of this bill, the American Dental Association does not appear to have an evidence-based guideline that twice yearly exams and cleanings is the correct frequency for all adults. CDA also acknowledges there is no evidence that two examinations is better than one for most people, although there is some evidence supporting more frequent preventive care visits for people with multiple risk factors such as smoking, diabetes, and a certain genotype. However, it is certain that covering up to two visits in Medi-Cal would provide a benefit for adults for which twice yearly visits are necessary based on their particular oral health circumstances.
   
   According to a February 2024 fact sheet published by DHCS, for the past several years, only about a quarter of adults in fee-for-service Medi-Cal Dental (the majority of Medi-Cal enrollees) had had an annual dental visit.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 9, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2701

Author:((Villapudua) – As Introduced Ver:February 14, 2024

SUBJECT: Medi-Cal: dental cleanings and examinations

SUMMARY: Requires Medi-Cal dental coverage of one additional prophlaxis cleaning and periodic dental exam per year for adults age 21 and over, thereby aligning standards that apply to adults and children by allowing both services to be billed twice a year for all Medi-Cal enrollees.

EXISTING LAW:

1. Establishes the Medi-Cal Program, administered by the department of Health Care Services (DHCS), to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) § 14000 et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes federally required and optional Medicaid benefits. [WIC §14132]
3. Specifies coverage of adult dental benefits. [WIC § 14131.10]
4. To the extent funds are made available in the annual Budget Act, covers one prophlaxis cleaning and periodic dental exam per year for adults age 21 and over. [WIC § 14132.88]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will expand California’s Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21 and over. With a second cleaning and exam, the author asserts, dentists can detect any oral health complications, prevent tooth loss, and even detect early heart problems as several reports suggest poor dental health is linked to diabetes, dementia, and cardiovascular diseases. The author concludes a second cleaning and exam is essential to maintain good oral health and overall health. This bill is sponsored by the California Dental Association (CDA).
2. BACKGROUND.
   1. Medicaid Requirements and State Optional Benefits. State Medicaid programs are required to provide certain benefits, and may choose to provide others at state option. All Medicaid programs cover 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 (EPSDT) benefit. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state (in California, the American Academy of Pediatrics “Bright Futures” periodicity schedule of preventive health care).
      
      Adult dental benefits are optional for states, meaning they have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. According to the Centers for Medicare and Medicaid Services, while most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum federal requirements for adult dental coverage.
   2. Medi-Cal Adult Dental Coverage and Recent Adult Dental Changes. Medi-Cal now covers a fairly comprehensive set of adult dental benefits at the state’s option. However, along with a list of other optional Medi-Cal benefits, adult dental benefits were eliminated from Medi-Cal in 2009 as a budget cost-cutting solution. In May 2014, pursuant to AB 82 (Committee on Budget), Chapter 23, Statutes of 2013, Medi-Cal adult dental benefits were partially restored. The 2014 restored benefits included basic preventive, diagnostic, restorative, anterior tooth endodontic treatment, complete dentures and complete denture reline/repair services. SB 97 (Committee on Budget and Fiscal Review), Chapter 52, Statutes of 2017, fully restored adult optional dental benefits that were not restored in May 2014, effective January 1, 2018, including additional exams, deep cleanings (scaling and root planing), laboratory crowns, partial dentures, and root canals in back teeth.
      
      Medi‑Cal will pay up to $1,800 in a year for covered dental services for adults, although there are exceptions for pregnancy and medically necessary services that exceed the $1,800 limit on a case by case basis.
      
   3. This Change Appears Consistent with Professional Recommendations and Other Dental Coverage… Dentists recommend twice yearly dental visits, and commercial plans generally cover the services at this cadence. According to Delta Dental, a large California dental insurer, their plans cover twice yearly dental visits for diagnostic and preventive care, and even incentivize utilization of these services by covering them with zero copayment and without counting the cost against the maximum plan benefit. In addition, it is self-evident that having a checkup more than once a year is opportunity for the dentist to catch early signs of cavities or other oral health diseases before they progress. According to the Centers for Disease Control and Prevention, 26% of adults in the U.S. have untreated tooth decay. Adults who are low-income are two times more likely to have untreated cavities than comparison groups. Establishing parity with commercial coverage for those insured by Medi-Cal would make coverage more equitable and provide greater opportunity to maintain oral health. Furthermore, according to the CareQuest Institute for Oral Health Medicaid Adult Dental Coverage Checker, 28 other state Medicaid programs allow two or more cleanings per year.
      
   4. …But the Evidence Basis is Surprisingly Thin. The U.S. Preventive Services Task Force makes recommendations for preventive health care, such as screenings, exams, and vaccines, and is known as a trusted source of exhaustively vetted, evidence-based, and expert recommendations. There does not appear to be a similarly authoritative, evidence-based source for preventive dental care, nor any firm professional guideline. Although the twice yearly cadence is commonly accepted in the dental community and the American Dental Association (ADA) issues a number of other evidence-based clinical practice guidelines, systematic reviews, and studies, the ADA does not appear to have an evidence-based guideline that twice yearly exams and cleanings is the “right” number for all adults. However, it is certain that covering up to two visits in Medi-Cal would provide a benefit for adults for which twice yearly visits are necessary based on their particular oral health circumstances. Finally, CDA indicates twice yearly is the standard of care.
      Further research on the effectiveness of once yearly versus twice yearly visits would be a valuable contribution to the scientific literature.
      
   5. Dental Provider Shortage and Low Utilization. It is important to consider the expansion of adult dental benefits in context of current utilization of the Medi-Cal dental program and overall challenges in access to dental providers. According to the February 2024 Dental Fee-For-Service and Dental Managed Care Performance Fact Sheet published by DHCS, Dental Utilization in Adults Ages 21+, only about a quarter of adults have had an annual dental visit over the last several years. This is among adults enrolled in fee-for-service Medi-Cal Dental (the majority of Medi-Cal enrollees), while utilization among adults enrolled in most dental plans in Sacramento and Los Angeles counties were even lower.
      
      According to the Health Services Resource Administration, 2.9 million Californians live in 535 designated health professional shortage areas. Dentists even in areas with an adequate workforce are less likely to accept new patients insured by Medicaid.
3. SUPPORT. This bill is supported by consumer advocacy organizations, the County Health Executives Association of California (CHEAC), and Association of Regional Center Agencies, among others. According to CHEAC, the Centers for Disease Control and Prevention notes dental disease and tooth loss is disproportionately high among individuals who have lower incomes, and over 40% of low-income non-Hispanic Black adults have untreated tooth decay which impacts the quality of life and productivity of those individuals. CDA indicates the current limit is contradictory to the standard of care, which is a minimum of two exams and cleanings a year, or every six months, to ensure maximum preventive care against dental diseases.
4. RELATED LEGISLATION. SB 980 (Wahab) expands Medi-Cal dental coverage for crowns and dental implants. SB 980 is pending in the Senate Appropriations Committee.
5. PREVIOUS LEGISLATION.
   1. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, requires DHCS to consider evidence-based practices consistent with the American Academy of Pediatric Dentistry and the ADA guidelines for all covered dental benefits, and provides Medi-Cal dental coverage of laboratory-processed crowns on posterior teeth for adults older when medically necessary to restore a posterior tooth back to normal function.
      
   2. AB 82 partially restored Medi-Cal adult dental benefits including basic preventive, diagnostic, and restorative services.
      
   3. SB 97 fully restored adult optional dental benefits that were not restored through AB 82.
      

REGISTERED SUPPORT / OPPOSITION:

Support

California Dental Association (sponsor)

Association of Regional Center Agencies

California Pan - Ethnic Health Network

California Retired Teachers Association

County Health Executives Association of California

Justice in Aging

Western Center on Law & Poverty, Inc.

Opposition

None on file.

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097