Medi-Cal Dental Benefits for Adults
On April 29, California Department of Health Care Services received Medicare approval to restore certain optional adult dental benefits for members 21 years of age and older under the Medi-Cal program, effective May 1. The partial restoration of dental services includes examinations and x-rays, dental cleanings with fluoride treatments, silver and tooth-colored fillings, and root canals and crowns on front teeth. Complete dentures are also being restored.
For a complete list of services being restored, please see Provider Bulletin Volume 29, Number 14 (August 2013). Dental providers will determine which medically necessary services will be provided, and the existing benefits for children will not change. When the elimination of the optional Medi-Cal dental benefit for adults began in July 2009, due to the state’s severe budget issues, there were several exemptions that allowed some members to continue receiving services. They included members who were residents of nursing homes and skilled nursing facilities, pregnant women, and some others.
This partial restoration of the benefit is not a component of the Affordable Care Act (ACA). Most of the costs are for individuals who are already eligible for Medi-Cal. Any ACA funding would be used for services to those who qualify for Medi-Cal only because of the ACA’s expanded eligibility.
If a member needs help finding a dentist, please see the Provider Referral Tool on the Denti-Cal website or call Denti-Cal at 1-800-322-6384.