1. Workforce Shortages/Dental Office Staffing
Even prior to the COVID-19 pandemic, dental practices in California were struggling with staff shortages, specifically a lack of dental assistants. First-year enrollment in dental assistant programs has declined 50% over the last 10 years. In recent months, the need to recruit dental staff has become even more prevalent as practices recover from the pandemic. Dental practices are stabilizing and have been able to rehire most team members, but staffing remains well below demand. Recent survey data shows that nearly 90% of practices have greater challenges in recruiting and hiring dental assistants than before the pandemic, and 44% of practices report that it’s limiting their ability to see more patients.
CDA is pursuing both immediate and long-term solutions through recruitment and training programs, state budget funding and legislation:
- CDA strongly supports the governor’s proposed investments in health care workforce expansion, which includes significant funding for the High Road Training Partnership, Health Care Workforce Advancement Fund, Multilingual Health Initiatives and the new Health Workforce and Education Training Council. CDA is advocating for these programs to include targeted investments focused on dental team pipeline development and apprenticeship programs. This builds upon existing funding for initiatives like CDA’s Smile Crew of California, designed to highlight careers in dental assisting and create a pool of qualified candidates.
- CDA is sponsoring AB 2276 by Assemblymember Wendy Carrillo (D-Los Angeles) to expand the scope of practice for dental assistants to include coronal polishing and placement of sealants under direct supervision if they have obtained the appropriate certifications. Currently, DAs can enroll and complete certification courses through the Dental Board of California to perform coronal polishing and apply sealants, but they cannot actually perform these tasks until they receive registered dental assistant licensure. Allowing DAs to perform duties to the limits of their certifications balances the needs of dental practices that are struggling to hire dental team members while also protecting patients by ensuring DAs are appropriately trained and supervised to perform these tasks.
2. Health Equity and Access Budget Proposals
Recognizing the state’s significant budget surplus, this year CDA is requesting one-time funding for two strategic investments in dental workforce and infrastructure to increase access to care for underserved, rural and vulnerable populations:
- $50 million to build new and expand existing special needs dental clinics and outpatient surgery centers through a grant program that would be operated by the California Health Facility Financing Authority. The funds can be allocated to pay for the construction, expansion or adaptation of dental surgical clinics or specialty dental clinics in California to increase access to oral health care for specialty populations. This expansion of settings will significantly expand access to dental care for individuals who are unable to undergo dental procedures in traditional dental offices due to special health care needs or the complexity of care needed.
- $10 million to fund the development of new and enhanced community-based clinical education rotations for dental students to improve the oral health of underserved groups in California. The Health Resources and Services Administration reported in 2021 a need for additional dental practitioners to meet the oral health needs of 2 million Californians living in dental health professional shortage areas (DHPSAs). The investment will be administered by a nonprofit foundation in collaboration with dental schools and will allow hundreds of dental students per year to serve in community settings in designated DHPSAs. This community-based education model is self-sustaining because the revenue generated by dental students providing treatment is sufficient to defray the cost after one year of implementation, so a one-time allocation can create sustained increases in access to care and permanent expansion of the dental workforce.
3. Medi-Cal Dental Program
More than half of children and a third of adults — over 14 million Californians — rely on the state’s Medi-Cal program for their medical and dental coverage. Historically, Medi-Cal patients have faced major barriers to care including long delays for appointments, trouble finding specialists and traveling long distances to receive care. A primary reason has been a lack of providers able to participate in the program due to administrative and enrollment barriers as well as reimbursement rates that had been among the lowest in the nation.
Making the Medi-Cal program functional has been a critical priority for CDA, and over the last five years the Medi-Cal dental program has made tremendous progress that the state must continue to build upon. This is a result of (1) improved reimbursement rates following the passage of Proposition 56 (2016), a tobacco-tax increase co-sponsored by CDA; (2) enhanced federal funding through the Medicaid waiver process that is continuing through the California Advancing and Innovating Medi-Cal (CalAIM) program; (3) restoration of adult dental benefits the state had eliminated during the Great Recession; and (4) improvements to administrative and enrollment barriers for providers. These changes have increased dental provider enrollment by 20% since 2017.
CDA is engaged on a number of Medi-Cal-related budget items this year including:
- Gov. Newsom’s budget proposal to backfill Prop. 56 tobacco tax declining revenues with general fund money, demonstrating a commitment to maintaining the program’s recent progress long-term and ensuring the state can maintain its supplemental rate increases for Medi-Cal providers, which were made permanent in last year’s budget.
4. AB 1982: Protection of Patient Choice in Teledentistry
The use of telehealth has significantly increased since the onset of the COVID-19 pandemic. While telehealth has proven to be an effective model of delivering care, third-party corporate telehealth providers operate in a completely virtual environment and generally have no relationship or interaction with a patient’s in-network provider. Last year, Gov. Newsom signed AB 457 (Santiago), which requires health plans and insurers to comply with specified notice and consent requirements if the plan or insurer offers a service via a third-party corporate telehealth provider. However, dental benefit plans were exempt from the requirements of AB 457 despite also steering patients to use third-party corporate telehealth providers. Telehealth is a useful tool in dentistry to triage patients experiencing pain or discomfort, but almost no dental care can be provided remotely. These triage appointments can unknowingly impact a patient’s visit frequency limitations and annual maximums before the patient even sees a dentist in person for necessary treatment. This year, CDA is sponsoring AB 1982 by Assemblymember Miguel Santiago (D-Los Angeles), which will ensure patients also have the ability to make an informed decision about how to access their dental care, as they do for their medical care, by removing the dental exclusion from statute and direct dental benefit plans to provide a disclosure of the impact of third-party telehealth visits on a patient’s benefit limitations. This bill will ensure patients receive quality telehealth services, protect the patient-provider relationship and provide better integration of care.
5. MICRA Repeal Ballot Measure — Oppose
The Medical Injury Compensation Reform Act allows injured patients to receive unlimited economic damages for all past and future medical costs, lost wages and lifetime earning potential. MICRA also allows up to $250,000 in noneconomic damages and includes a limit on attorneys’ fees, stabilizing liability costs and reducing incentives for frivolous lawsuits against health care providers. A trial lawyer-funded ballot measure has qualified for the November 2022 election, which would essentially eliminate MICRA’s protections by creating a new “catastrophic injury” category that does not include a cap on noneconomic damages and eliminates the caps on attorneys’ fees. This measure would significantly raise health care costs and reduce access to care for those who need it most, including people who use Medi-Cal, county health programs, safety-net providers and school-based health centers.
CDA is part of Californians to Protect Patients and Contain Health Care Costs, a broad coalition including physicians, nurses, hospitals, safety-net clinics and other health care providers that are opposing this initiative.
6. Dental Plan Accountability & Transparency
Over the past several years, CDA has worked to improve the transparency and value of dental benefit plans, hold dental plans accountable for how they spend premium dollars and level the playing field for dentists and consumers. Furthermore, the COVID-19 pandemic highlighted the ability of medical and dental plans to make record profits during a public health emergency by collecting the same amount in premiums while paying fewer claims, as patients were receiving care less often. Since the onset of the pandemic, costs of personal protective equipment (PPE) have skyrocketed and been incredibly unpredictable, issues exacerbated by product scarcity, supply chain disruptions and price gouging. Many providers are still paying in the range of $10 to $25 per patient for medically necessary PPE, adding up to thousands of dollars of extra costs every month. Dental plans did not share in the burden of these costs in any substantial way, worsening the longer-term trend in which payments from plans remain stagnant while the cost of providing care continues to rise. CDA has advocated for a number of bills signed into law in recent years that strengthen transparency and accountability of dental plans.
7. Direct-to-Consumer Orthodontic Consumer Protections
Providing dental care that involves the movement of teeth without a proper evaluation, including X-rays, can lead to serious patient harm, such as loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of direct-to-consumer (DTC) business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care. CDA will continue to work with the appropriate enforcement entities, including the dental board, to push for increased patient safety while pursuing improved statutory and regulatory enforcement.
Updated March 2022