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Oral Health for All CaliforniansFREE Webinar Series for Advocates & Community-Based Organizations
6/28/2018 11 am- 12 pm Webinar #2Oral Health Procedures: Coverage & Access
Why this webinar? CPEHN partners told us that knowing how to navigate oral
health services is a priority in their communities.
We hope that you will join us and experts from across the state to learn about oral health, the Denti-Cal system, and successes and challenges in connecting our communities to better care.
Proposed webinars: Oral Health Systems: Navigating Denti-Cal – 5/31 11am Oral Health Procedures: Coverage & Access- 6/28- TODAY! Oral Health Workforce: Expanding Reach- TBD Oral Health in Our Communities: Successes & Challenges 8/23
(TENT)
Your resourceKeerti Kanchinadam-- FacilitatorNorthern California Policy and Outreach Manager | [email protected]
Dr. Irene HiltonDental Consultant | National Network for Oral Health [email protected]
Liz Ramirez, Director of Training and Education | Maternal and Child Health [email protected]
Dental Coverage
Liz Ramirez, Director of Training and EducationMaternal and Child Health Access
Maternal and Child Health Access’s mission is to improve the health of low-income women and their families through
advocacy, education, training and services.
Medi-Cal is California's Medicaid program. This is a public health insurance program that provides needed health
coverage for low-income residents of California.
Timeline of CA Oral Health Benefits1980’s – June 2009
- Adult Medi-Cal beneficiaries had access to dental services (e.g., exams, x-rays, and teeth cleanings); emergency treatment for control of pain and infection; fillings; tooth extractions; root canal treatments; prosthetic appliances (e.g., dentures).- Children eligible for Medi-Cal had full benefits
July 2009- Dental benefit for most adult beneficiaries was terminated.- Most of the Medi-Cal adult dental benefits were eliminated due to the state’s budget deficit. - Children’s services, as required by federal law, continue to be delivered.
May 2014Partial Restoration
of Adult Dental Services, including
full benefits for pregnant women in ALL aid codes
January 2018Full Restoration of Adult Dental Services
These are the benefits that the federal government/law mandates
• Procedures that were not normally utilized by regular beneficiaries such as root canals, fillings or full dentures.
• Instead they were benefits that treated or alleviated major trauma such as a gun shot to your mouth or jaw.
• Covered medical service such as surgery for a heart condition
• The federal government has determined certain dental benefits to be “federally required” and must be provided for all beneficiaries regardless of aid code or immigration status.
• These benefits are referred to as FRADSand stand for Federally Required Adult Dental Services.
• Back in 2009 when adult dental was eliminated, FRADS were still available for beneficiaries and still are today.
FRADS
https://www.denti-cal.ca.gov/
The dental portion of Medi-Cal is called Denti-Cal.
Exceptions:* ONLY a benefit under age 3
** 1. Not a benefit under age 132. Over age 21, allowable under special circumstances
for posterior teeth(See Benefits Quick Reference Guide – 2018)
*** Not a benefit under age 13. Allowable under special circumstances
Full Dental Restoration for adults!
Coverage for Children
Age/Group Medi-Cal coverage Dental benefit Important
Children (under 21) Full scope Full coverage Eligible for EPSDT
Children (under 19) Full scope(SB75)
Full coverage Eligible for EPSDT
* Federal law requires Medi-Cal to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services to all Medi-Cal-eligible children under age 21. EPSDT covers a broad variety of preventive,diagnostic, and treatment services. It is designed to ensure that low-income children receive the health check-ups and treatment that they need as early as possible, so as to avoid or lesson chronic conditions and health care costs. Children are also entitled to all Medi-Cal services they need to “correct or ameliorate” conditions and illnesses revealed by screenings.
http://www.healthlaw.org/issues/child-and-adolescent-health/epsdt/epsdt-is-essential-march-2017#.WzJ2xfZFx9A*
What happens when the beneficiary turns 19?
A re-evaluation of income takes place before the beneficiary's 19th
birthday.
# Persons
138% FPL
MAGI Medi-Cal
Adults* 19-64
266% FPL
MAGI Medi-Cal
TLICP Children 0 to 19
CHDP
1 $1397 $2692 2 $1893 $3649 3 $2390 $4607 4 $2887 $5564 5 $3384 $6522 6 $3881 $7480
Additional person, add: $ 497 $958
Medi-Cal SB-75 Beneficiaries
The beneficiary immigration status is re-evaluated along with income and if there has been no change of immigration status, the benefits with be reduced to Limited Scope Medi-Cal and FRADS.
Age/Group Medi-Cal coverage Dental benefit
Adults (over 21) Full scope Full restoration
Adults (over 21) Limited scope FRADS + *3 dental benefits that DDS provides
Coverage for Adults
*Temporary crown (fractured tooth), removal of a portion of the pulp to alleviate swelling and pain, pulpotomy
Pregnant women (over 21) Full scope Full Restoration* Full coverage
Pregnant women (over 21) Limited scope / Pregnancy only
* Full coverage during pregnancy and post-partum.
Pregnant women (under 21) Full scope *Full coverage + EPSDT
Pregnant women (19 - 21)
Limited scope / Pregnancyonly
* Full coverage during pregnancy and post-partum.
Coverage for Pregnant Women
Pregnancy Medi-Cal is considered Minimal Essential coverage = Full Scope coverage!
Age/Group Medi-Cal coverage Dental benefit
FFS and MC PlanFee For Service and Managed Care Plan
One Pilot
Los Angeles
Sacramento
Fee For Service and Managed Care
Geographic Managed Care
Beneficiaries in LA County are the only ones with the option of FFS or MC.
There are three dental managed care plans in Los Angeles County:
1. Access Dental Plan, Inc.(888) 414-4110www.premierlife.com
2. Health Net of California, Inc.-Dental(800) 977-7307www.healthnet.com
3. Liberty Dental Plan of CA, Inc.(888) 703-6999
www.libertydentalplan.com
Denti-Cal Website
http://www.denti-cal.ca.gov
On the website:• Find a Denti-Cal provider• Provider Seminars• Provider bulletins and
handbook• Dental resources
Directory of Providers
For assistance in finding a dentist who accept new patients for the Medi-Cal Dental Program, call toll-free (800) 322-6384, Monday through Friday, 8:00 a.m. to 5:00 p.m.
InsureKidsNow.gov
Helping your clients
When in doubt, call Denti-Cal Telephone Service Center for help at 1-800-322-6384 or email [email protected]◦ Help in locating a Medi-Cal dental provider in your area.◦ Clinical screening appointment information.◦ Questions regarding your Treatment Authorization Request (TAR).◦ General Medi-Cal Dental program questions.◦ How to file a grievance/complaint.
Call Maternal and Child Health Access for assistance with all
high risk cases, especially pregnant women (213) 749-4261.
Covered California: The Health Exchange
The Exchange = Marketplace = Covered California
139% to 400% of the FPL = Premium Assistance/Tax Credits/Subsidies
139% to 250% of the FPL = Cost Sharing Reductions/Subsidies
It is the ONLY place (if eligible) you can receive Premium Assistance or Cost Sharing Reductions
Dental benefits are included in the family plans.
All family plans with children (up to age 19) who are enrolling have dental coverage. So all kids enrolling have medical and dental as part of their package (mandatory).
As of November 1, 2016, adults may choose to add dental as part of their coverage, and purchase it separately. Dental coverage does not qualify for subsidies; tax subsidies apply to the medical coverage only.
Covered California 2018 Health Plan Embedded Pediatric Dental
Anthem Blue Cross of California Anthem Blue Cross DHMO, DPPO
Blue Shield of California Dental Benefit Providers DPPO, DHMO
Chinese Community Health Plan Delta Dental of California DHMO
Health Net Dental Benefit Providers DHMO, DPPO
Kaiser Permanente Delta Dental of California DHMO
L.A. Care Health Plan Liberty Dental Plan DHMO
Molina Healthcare California Dental Network DHMO
Oscar Health Plan of California Liberty Dental Plan DHMO
Sharp Health Plan Access Dental Plan DHMO
Valley Health Plan Liberty Dental Plan DHMO
Western Health Advantage Delta Dental of California DHMO
Shop and Compare
Federally Qualified Health Centers (FQHCs) provide medical primary care and preventive dental services. Those with dental clinics can provide more extensive treatment. Also called Community Clinics.• Can provide dental for those without coverage
Health Resources & Services Administrationhttps://www.findahealthcenter.hrsa.gov/
Community Clinic Association of Los Angeleshttps://ccalac.org
https://www.californiahealthplus.org/CHPlus/Find_My_Health_Plus_Center/CHPlus/FIND_MY_HEALTH__CENTER/Clinic_Finder.aspx?hkey=9cd9f887-b092-4439-a9bc-7032454c9273
Questions and contact informationMaternal and Child Health Access1111 West Sixth Street, Fourth Fl.
Los Angeles, CA 90017213 – 749-4261
Oral Health ProceduresTranslated for non-dentists!
Irene Hilton, DDS, MPHNational Network for Oral Health Access (NNOHA) &
San Francisco Department of Public Health
Exams/Evaluations
Also called
• Check-up
• Number allowed per year varies by age
Notes
• Usually get x-rays• Usually when the
dentist tells you what you need, what’s covered or not by insurance
Dental Diseases
Dental Caries
• Also called:Cavities, decay
Periodontal Disease
• Also called:Gum disease
Preventive Services- Category
• Procedures that are supposed to prevent dental disease (cavities or gum disease)
• Fluoride• Sealants• Prophylaxis (cleaning)
Fluoride
What is it?
• Natural element that makes teeth stronger against acid that causes cavities
• Fluoride varnish, foam
Sealant
What is it?
• Thin plastic finger nail polish-like covering that covers the ridges of back teeth so cavities don’t form
Prophylaxis (cleaning)
What is it?
• Cleaning with the dental handpiece with rubber cup or electric toothbrush or toothbrush (infants)
• “Lite” cleaning
Scaling & Root Planing
Also called
• “Deep cleaning”• Treatment for gum
disease• May need to numb up
mouth• May do a quarter of
mouth at a time
Extractions
Also called
• Pulling teeth, removing teeth, taking teeth out
Reasons to pull teeth
• Cavity• Gum disease• Trauma• Orthodontics
Restorative Services- Category
• Procedures to replace tooth structure or teeth lost because of dental disease
• Fillings• Crowns• Root canals• Dentures
Amalgam Fillings- “Silver fillings”
Pros
• Lasts the longest• Easy to put in• Same hardness as
natural tooth
Cons
• Doesn’t look good• Larger fillings more
likely to break tooth later
• Teeth can be sensitive after filling put in
Composite Fillings- “Tooth colored fillings”
Pros
• Looks good• Holds tooth together
Cons
• Doesn’t last as long• Very technique
sensitive• Tooth can be at
higher risk for nerve death
Crown
Also called
• Cap
• Treatment when too much tooth structure needs to be replaced for a filling to work
• Fillings go in teeth• Crowns go around
Pre-fabricated Crown
• Pre-made• Not a perfect fit at the
edges• Color may not match
exactly for front teeth• Stainless steel for
back teeth
Laboratory Processed Crown
• Custom-made• Perfect fit at the
edges• Color match• May be allergic to the
metal used• Expensive compared
to pre-fabricated
Root Canals
What is it?• Removing infected
nerve from inside tooth, cleaning, disinfecting and sealing the tooth
• Saves teeth that would otherwise be pulled
• Tooth becomes brittle
Dentures
Also called• Plates, false teeth
• Replacements for lost teeth
• Removable• Partial denture• Full denture
Contact!National Network for Oral Health Access181 E 56th Avenue, Suite 401Denver, CO 80216Phone: (303) 957-0635www.nnoha.org
Irene V. Hilton, DDS, [email protected]
[email protected] Silver AvenueSan Francisco, CA 94134Phone: 415-657-1708
