CDA Major Issues & Priorities
4. Dental Plan Transparency
1. Proposition 56 Medi-Cal Funding
More than half of California's children and a third of its adults - more than 13 million Californians - now rely on the state's Medi-Cal program for their medical and dental coverage. The passage of Proposition 56 in 2016 - a tobacco-tax increase co-sponsored by CDA - has led to significant Medi-Cal funding improvements. Medi-Cal patients have faced major barriers to care for many years, including long delays for appointments, trouble finding specialists and traveling long distances to receive care. A primary reason for this has been that California's reimbursement rates to Medi-Cal providers have been among the lowest in the nation, resulting in a lack of providers who are able to participate in the program. Proposition 56 funds have helped address this in a significant way, allocating over $ 500 million per year on significant rate increases for hundreds of dental procedures, bringing total reimbursement for many common procedure codes to 75% to 80% of average commercial rates. The changes are producing results: The number of enrolled dentists has increased 10% since 2017 and, in combination with additional provider incentives and administrative reforms, the state is finally seeing increases in the number of children and adults receiving necessary oral health services.
The 2019-20 budget continues the current supplemental Medi-Cal provider rates through the end of 2021 and includes an additional $20 million dedicated to dentists committed to serving Medi-Cal patients in a recently launched student loan repayment program, CalHealthCares. Because of the additional funds this year, CalHealthCares will be able to make additional awards available in 2019, leading to more increases in Medi-Cal's provider workforce. While fixing the Medi-Cal program will be a long-term process, CDA is optimistic about the progress made since the passage of Proposition 56 and will continue to advocate for a long-term commitment to the current reimbursement rates. This is essential in order to provide certainty for providers and maintain stability in the program.
2. Universal Health Care
CDA is committed to building upon the existing health care delivery system to extend health coverage to all Californians. We support the actions taken in the 2019-20 state budget to expand coverage, increase affordability and stabilize the individual insurance market. The budget includes new and larger subsidies for middle-class Californians to purchase insurance through Covered California, a state-level individual mandate to purchase health insurance and an expansion of Medi-Cal benefits to all young adults through age 25 regardless of their immigration status. We will continue working with lawmakers to achieve universal coverage that includes dental care and to protect the significant progress the state has made under the Affordable Care Act (ACA). Under the ACA, California has achieved a larger reduction in its uninsured rate than any other state by creating the country's largest and most robust state health insurance exchange (Covered California), which includes stand-alone family dental plans. We are urging the state to pursue universal health care in a way that is sustainable, that does not upend the progress made under the ACA and that maximizes funding from the federal government, which currently provides more than half of the state's health care dollars.
3. AB 954: Dental Plan Network Leasing – Sponsor
CDA is sponsoring AB 954 (Wood) to require dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan. The growing trend of network leasing is causing confusion and difficulties for California dentists and their patients. Some dentists want the benefits that can come with network leasing, like increased visibility and patient retention. However, the disadvantages are that oftentimes dentists who signed contracts with one dental plan aren’t aware that their contract is being sold or which plans they have been sold to, nor is the purchasing plan required to comply with the terms the provider and the original plan agreed to. Additionally, there is no requirement for the dental plan that is leasing its network to communicate with the purchasing plan to make sure that a dentist who opts-out or cancels their contract is taken off the leased network. Lack of transparency in network leasing can cause confusion for patients and dentists, making it difficult for providers to educate patients about treatment options and the cost of care. Dentists need to know whether they are in network or out of network when working with a patient to determine their share of the costs and dentists must be able to easily locate the terms of a new contract to know important limitations on services, waiting periods, how treatments are categorized and co-payment rates.
AB 954 will make a number of changes to address this, including: 1) requiring dental plans to clearly identify a contract clause allowing network leasing, 2) maintaining an up-to-date website list of all third parties who have access to a provider network contract, and 3) giving dentists the ability to opt out. The bill will provide clarity for both patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship. AB 954 passed out of the Assembly with unanimous support and is now in the state Senate.
Californians deserve accountability and value from their dental benefit plans and AB 954 (Wood) builds on a series of recent successful legislative efforts sponsored by CDA that have greatly increased the transparency of these plans. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, known as a dental loss ratio (DLR). The reported data shows a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50 percent of premiums on care and some plans even falling below 10 percent. SB 1008 (2018) builds upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This will provide plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations, and exceptions. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.
5. Sugar-Sweetened Beverages (SSBs)
CDA and the California Medical Association are leading efforts to reduce SSB consumption and have launched a campaign - Soda's Sticky Business - highlighting the industry's deceptive marketing tactics targeting children and low-income and minority communities. As part of that effort, CDA is supporting legislation aimed at reducing the consumption of sugary beverages including soda, energy drinks, sugar-added juices and sports drinks. SB 347 (Monning) will require a warning label on sugary drinks to help educate consumers as they make their purchasing decisions. The label would read: "STATE OF CALIFORNIA SAFETY WARNING:Drinking beverages with added sugar(s) may contribute to obesity, Type 2 diabetes, and tooth decay. "CDA has also focused on several other SSB-related bills this year such as AB 764 (Bonta), which limits promotional pricing incentives used by the beverage industry to heavily subsidize discounts on SSBs. It is now a two-year bill.
SSBs are the single largest source of added sugar in the American diet and a primary cause of various health conditions including tooth decay, which affects more than two-thirds of California children (making it the most common chronic childhood disease). The frequency of consumption along with the combination of high levels of sugar and acid make these beverages uniquely damaging to teeth and overall health. Sport, energy and soft drinks are leading to unprecedented levels of decay and loss of tooth enamel for a new generation of youths and young adults. The overconsumption of sugary, acidic drinks is reversing more than 50 years of public health gains realized through preventive measures such as fluoridated water and dental sealants.
Additionally, CDA and the CMA are co-sponsoring a ballot measure for the November 2020 election to establish a statewide tax of 2 cents per ounce on the distribution of SSBs, which would raise at least $2 billion in revenue for critical health programs and reverse a recently passed moratorium on local SSB taxes, preserving the ability of local communities to make their own decisions on combating SSB consumption.
6. SB 154: Silver Diamine Fluoride – Sponsor
7. State Office of Oral Health – Proposition 56 Funding
CDA is sponsoring SB 154 (Pan) this year to add silver diamine fluoride (SDF) as a Medi-Cal benefit for treatment of dental decay when applied as part of a comprehensive treatment plan. SDF is a topical medication used to slow down or stop cavities in both primary and permanent teeth. The use of SDF is a nonsurgical approach to treating dental decay, as it does not require local anesthetic and can be applied quickly and painlessly. SDF is a colorless liquid that contains both silver and fluoride; although it stains the decayed portion of a tooth, it is becoming more widely used, especially in posterior and primary teeth. In California, Medi-Cal is already using SDF as part of a broader pilot project in 29 counties to manage dental decay in children under 6 years old.
Recent studies of Medicaid expenditures in six states show an average savings of $100 to $350 per child treated with SDF. This could translate to $10 million to $30 million in annual savings for California's Medi-Cal program. SDF is a proven effective tool worldwide in managing cavities and the serious health problems associated with unmanaged dental decay and is now being shown to provide significant cost savings for public health insurance programs. While SDF may not fully eliminate the need for additional care, it gives Medi-Cal providers a new and effective tool to treat dental decay among the growing Medi-Cal population.
CDA’s Access Plan to reduce barriers to oral health care prioritizes the need for a comprehensive state oral health program led by a state dental director. The state began providing ongoing funding for a dental director and the Office of Oral Health (based in the Department of Public Health) in the 2014-15 budget for the first time in decades, and Jay Kumar, DDS, MPH, was appointed to the position in 2015. Dr. Kumar came to California with more than 25 years of experience in the New York State Bureau of Dental Health, where he also held the position of state dental director and developed the first comprehensive state oral health plan for New York. Dr. Kumar and stakeholders including CDA have developed a state oral health plan that includes several objectives, such as building community-clinical linkages, expanding access to fluoride, dental sealants and screenings, dental coverage, tobacco-use counseling and interventions, and developing programs that promote oral health literacy and healthy habits. This effort received a strong boost from the passage of Prop. 56, which includes an annual $30 million for the state oral health program – a tenfold funding increase and the first time the program has ever had a dedicated revenue source.
Updated June 21, 2019
ADA Response to "The Truth About Dentistry" article in The Atlantic
ADA communications staff is currently preparing a response to a story in The Atlantic titled, “The Truth About Dentistry.” The article alleges dentistry lags behind the medical profession and is not largely scientific and evidence-based in regard to diagnoses and treatment. The story also serves to reinforce negative stereotypes of dentists and focuses on one example of a dentist (now a retired life ADA member) who is currently being prosecuted for insurance fraud and has settled multiple lawsuits related to overtreatment and fraudulent billing activity.
ADA communications staff was not contacted by the reporter, who began working on this story two years ago. We learned of the story when he contacted an employee in the ADA Science Institute. The reporter interviewed this ADA employee, but he was not quoted – likely because his quotes did not support the apparent slant the reporter was pursuing.
ADA staff is currently working on a response to the article. A standby statement is in development and we will share when it’s finalized. If you receive a media inquiry and would like assistance, please don’t hesitate to contact me. These pages on MouthHealthy.org may also be helpful if you see any negative chatter on social media and would like to respond:
The ADA is engaging a number of communications tactics to share positive stories about the amazing work dentists are doing, including posting on Facebook and Twitter, which you can feel free to share from your own channels. We are also spreading the word to the public about how to be an informed consumer of dental care – look for a new infographic on social media in the next couple days. When sharing these positive stories, we would advise against mentioning The Atlantic story, as we do not want to give it more credence than it’s already received.
Thanks for your time. As always, please let me know if we can be of assistance. Thank you!
Mike Bittner firstname.lastname@example.org
Division of Integrated Marketing & Communications