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Restoration of Adult Dental Services
Senate Bill 97 (Chapter 52, Statutes of 2017) fully restored adult optional dental benefits that were not restored in May 2014. This policy is effective January 1, 2018. DHCS is notifying beneficiaries and providers via the notices posted below.
DHCS submitted a State Plan Amendment (SPA 17-027) to the Centers for Medicare and Medicaid Services (CMS) to restore adult optional dental benefits for beneficiaries ages 21 and older with full-scope coverage. Restored benefits will include, for example, laboratory processed crowns, posterior root canal therapy, periodontal services, and partial dentures, including denture adjustments, repairs, and relines. The full dental benefits are listed in the Dental Provider Handbook, Section 5, Manual of Criteria, posted on the Denti-Cal website. These benefits will be available for beneficiaries in both Dental Fee-for-Service and Dental Managed Care delivery systems.
Adult optional dental benefits were eliminated from the Medi-Cal state plan in 2009. In May 2014, pursuant to Assembly Bill 82 (Chapter 23, Statutes of 2013), DHCS partially restored Medi-Cal adult optional dental benefits. The 2014 restored benefits included basic preventive, diagnostic, restorative, anterior tooth endodontic treatment, complete dentures and complete denture reline/repair services.
Adult dental benefits that remain in place and do not change as a result of either the 2014 or 2018 restorations:
• Pregnancy-related services
• Emergency services
• Services provided to residents of an Intermediate Care Facility/Skilled Nursing Facility
• Services provided to consumers of the Department of Developmental Services