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Medi-Cal Dental Managed Care
The Department of Health Care Services (DHCS) is responsible for providing dental services to eligible Medi-Cal beneficiaries, and offers services through two delivery systems, Dental Fee-For-Service (FFS) and Dental Managed Care (DMC). Dental FFS was the exclusive and original delivery system offered in California’s 58 counties. However, in 1995, pursuant to a state law change, DHCS implemented DMC to explore the effectiveness of DMC as a delivery system of dental services. The DMC delivery model currently operates in two of the state’s 58 counties, Sacramento and Los Angeles. In Sacramento County, DMC enrollment is mandatory, with few exceptions. In Los Angeles County, a beneficiary must opt-in to participate in the DMC program.
The Department contracts with three Geographic Managed Care (GMC) Plans in Sacramento County, and three Prepaid Health Plans (PHP) in Los Angeles County that provide dental services to Medi-Cal beneficiaries. All Medi-Cal DMC plans are licensed by the State of California, Department of Managed Health Care, pursuant to the Knox-Keene Health Care Service Plan Act of 1975. Medi-Cal DMC beneficiaries receive dental services from providers within the plan's provider network. DMC covered dental services are the same services provided under the Dental Fee-for-Service (FFS) Program.
For information regarding the Dental Managed Care Directed Payment program, please visit the Directed Payments webpage.
Contracts and All Plan Letters
Plan Accreditation Reports
Note: 42 CFR 438.332 requires state Medicaid agencies to make the accreditation status for each contracted managed care plan available on their website. In accordance with this requirement, DHCS notes that none of the Dental Managed Care plans have been accredited for their Medi-Cal lines of business with a private independent accrediting entity.
Consumer Satisfaction Surveys (by Dental Plan)
Department of Managed Health Care Reports
Health Net of California: