Medical: What Is Covered Now For California Dental
In 2009, the California Medi-Cal program eliminated most dental benefits for adults; children’s services are still a covered benefit. A court challenge briefly returned adult dental care to the Medi-Cal program, but a final ruling in May upheld the elimination of adult benefits. “This has been a real blow to services for many of our patients,” states Carter Wright. “We still offer services to adults, and we work out discounts and payment plans, but a lot of people still choose not get the treatment they need.” This ruling cut most dental benefits for adults throughout California. “Virtually all adults were affected by these cuts,” says Dr. Wright.
“For adults, Medi-Cal pays for treatment that relieves pain and infection. It doesn’t cover work that saves teeth. The Medi-Cal cuts certainly weren’t our choice, but we’re stuck with the regulations,” explains Dr. Wright. “Medi-Cal pays for extraction, not restoration.”
Current law requires that Medi-Cal pay for treatment related to the relief of pain, infection and trauma; however, the treatment option is tooth removal. “We will work with patients to find ways to treat the problem without removing teeth that can be saved, but many patients just can’t afford the work,” notes Dr. Wright. Medi-Cal eliminated what were termed optional benefits. Medi-Cal will no longer pay for most oral examinations, fluoride treatments, fillings for cavities, root canals and crowns, treatment of gum disease, complete or partial dentures and bridges or repairs to existing dentures, partials or bridges – virtually all procedures that save teeth or restore function.
On a positive note, Medi-Cal covers most dental services for anyone under the age of 21, and some services for women who are pregnant and adults who live in skilled nursing facilities or care homes. “We really encourage parents to bring their children in for a routine exam as soon as the child’s teeth start coming in,” says Samantha Hani, lead registered dental assistant at Burre Dental Center. “Starting a routine of good oral health right from the start will prevent most problems later on. We always find a way to make room for children and teenagers. We’ll fast-track pregnant women and coordinate our care with prenatal providers as necessary.”
Samantha continues, “Though most dental services for adults are no longer covered by Medi-Cal, we still offer comprehensive dental care to the community. We accept CMSP and private insurance and we’ll work out a payment plan for folks who don’t have any dental insurance. The demand for care has increased and it’s hard to get an appointment, but keep trying. Our staff is doing their best help you get the quality care you need.”