Updated January 31, 2019
Medi-Cal – Proposition 56 Funding
More than half of children and a third of adults — over 13 million Californians — now rely on the state’s Medi-Cal program for their medical and dental coverage. The passage of Prop. 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. We are pleased to see that Governor Newsom’s proposed 2019-20 budget maintains the same level of dental provider reimbursement funding from Prop. 56 ($210 million), which has resulted in rate increases of at least 40 percent across a wide range of procedures including adult prevention and treatment, gum disease, dentures, surgical services, anesthesia, and paying for extra time when treating patients with special needs. Adding to this progress, the 2018-19 budget includes $30 million from Prop. 56 funds for a new dental school loan repayment program, which should improve access to dentists in underserved areas. While fixing the Medi-Cal program will be a long-term process, CDA is very pleased with the progress made since the passage of Prop. 56 and is working to ensure that Prop. 56 funds are allocated in the state budget as permanent base-rate changes rather than as one-year supplemental payments, which is essential to providing certainty for providers and maintaining stability in the program.
Universal Health Care
CDA is committed to building upon the existing health care delivery system to extend health coverage to all Californians. We are encouraged by Governor Newsom’s proposals to expand coverage, increase affordability and stabilize the individual insurance market. We are eager to work 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, and expanding Medi-Cal eligibility to millions of new beneficiaries. 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.
Dental Plan Transparency
Californians deserve accountability and value from their dental benefit plans and recent legislation sponsored by CDA has 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.
SB 154: Silver Diamine Fluoride – Sponsor
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 28 rural counties to manage dental decay in children under 6 years old. 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. SDF is an effective, noninvasive and low-cost option for slowing or stopping the growth of cavities and should be available when treating the Medi-Cal population.
Sugar-Sweetened Beverage Tax
CDA and the California Medical Association are co-sponsoring a ballot measure for the November 2020 election to establish a statewide two-cent-per-ounce tax on the distribution of sugar-sweetened beverages (SSBs), such as sodas, energy drinks and sugar-added juices. SSBs are the single largest source of added sugar in the American diet and a primary cause of diabetes and dental decay, which is the most common chronic childhood disease experienced by more than two-thirds of children in California. 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. SSBs are also displacing consumption of milk, the principle source of calcium in the diet, which is critical to the development of healthy teeth. The ballot measure follows the passage of local SSB taxes in four California cities since 2014 and responds to recent legislation that enacted a 12-year moratorium on any new local SSB taxes. That legislation passed in exchange for the withdrawal of a ballot measure backed by the beverage industry that would have required a two-thirds vote on all local tax increases. The CDA/CMA-sponsored initiative would raise at least $2 billion in revenue for critical health programs and reverse the moratorium on local SSB taxes, preserving the ability of local communities to make their own decisions on combating SSB consumption.
State Office of Oral Health – Proposition 56 Funding
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.