Major Issues and Priorities

Updated May 8, 2019

Proposition 56 Medi-Cal Funding
More than half of children and a third of adults — more than 13 million Californians — now rely on the state’s Medi-Cal program for their medical and dental coverage. The passage of Prop. 56 in 2016 – a tobacco-tax increase co-sponsored by CDA – has led to significant Medi-Cal funding improvements. Medi-Cal patients have faced major barriers to care for many years, including long delays for appointments, trouble finding specialists and traveling long distances to receive care. A primary reason for this has been that California’s reimbursement rates to Medi-Cal providers historically have been among the lowest in the nation, resulting in a lack of providers who are able to participate in the program. Prop. 56 funds have helped address this in a significant way, with $210 million going to significant rate increases for hundreds of dental procedures, and it is producing results. The number of enrolled dentists has increased 10 percent since 2017 and, in combination with additional provider incentives and administrative reforms, the state is finally seeing increases in the number of children and adults receiving necessary oral health services.

We are pleased to see that Governor Newsom’s proposed 2019-20 budget maintains the current provider reimbursement funding from Prop. 56 and that his administration has expressed a commitment to make them ongoing. While fixing the Medi-Cal program will be a long-term process, CDA is very optimistic about the progress made since the passage of Prop. 56 and we are advocating for a long-term commitment to the current reimbursement rates, as opposed to one-year supplemental payments. This is essential in order to provide certainty for providers and maintain stability in the program.

Universal Health Care
CDA is committed to building upon the existing health care delivery system to extend health coverage to all Californians. We are encouraged by Governor Newsom’s proposals to expand coverage, increase affordability and stabilize the individual insurance market. We look forward to working with lawmakers to achieve universal coverage that includes dental care and to protect the significant progress the state has made under the Affordable Care Act (ACA). Under the ACA, California has achieved a larger reduction in its uninsured rate than any other state by creating the country’s largest and most robust state health insurance exchange (Covered California), which includes stand-alone family dental plans, and expanding Medi-Cal eligibility to millions of new beneficiaries. We are urging the state to pursue universal health care in a way that is sustainable, that does not upend the progress made under the ACA and that maximizes funding from the federal government, which currently provides more than half of the state’s health care dollars.

AB 954: Dental Plan Network Leasing – Sponsor
CDA is sponsoring AB 954 (Wood) to require dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan. The growing trend of network leasing is causing confusion and difficulties for California dentists and their patients. Some dentists want the benefits that can come with network leasing, like increased visibility and patient retention. However, the disadvantages are that oftentimes dentists who signed contracts with one dental plan aren’t aware that their contract is being sold or which plans they have been sold to, nor is the purchasing plan required to comply with the terms the provider and the original plan agreed to. Additionally, there is no requirement for the dental plan that is leasing its network to communicate with the purchasing plan to make sure that a dentist who opts-out or cancels their contract is taken off the leased network. Lack of transparency in network leasing can cause confusion for patients and dentists, making it difficult for providers to educate patients about treatment options and the cost of care. Dentists need to know whether they are in network or out of network when working with a patient to determine their share of the costs and dentists must be able to easily locate the terms of a new contract to know important limitations on services, waiting periods, how treatments are categorized and co-payment rates.

AB 954 will make a number of changes to address this, including: 1) requiring dental plans to clearly identify a contract clause allowing network leasing, 2) maintaining an up-to-date website list of all third parties who have access to a provider network contract, and 3) giving dentists the ability to opt out. The bill will provide clarity for both patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship.

Dental Plan Transparency
Californians deserve accountability and value from their dental benefit plans and AB 954 (Wood) builds on a series of recent successful legislative efforts sponsored by CDA that have greatly increased the transparency of these plans. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, known as a dental loss ratio (DLR). The reported data shows a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50 percent of premiums on care and some plans even falling below 10 percent. SB 1008 (2018) builds upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This will provide plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations, and exceptions. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.

Sugar-Sweetened Beverages (SSBs)
CDA and the California Medical Association are leading efforts to reduce SSB consumption and have a launched a campaign – Soda’s Sticky Business – highlighting the industry’s deceptive marketing tactics targeting children and low-income and minority communities. As part of that effort, our two organizations are supporting legislation aimed at reducing the consumption of sugary beverages including soda, energy drinks, sugar-added juices and sports drinks. Two bills remain active this year:

  • AB 764 (Bonta) would stop the soda industry from targeting consumers with promotional pricing strategies that make soda cheaper than water. It will prohibit beverage companies from reducing the price of their sugary products through discretionary promotional and marketing incentives that target communities lacking easy access to healthy, affordable foods, and are especially prevalent in low-income communities who are already at higher risk for diabetes, obesity, and epidemic tooth decay.
  • SB 347 (Monning) will require a warning label on sugary drinks to help educate consumers as they make their purchasing decisions. The label would read: “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) may contribute to obesity, type 2 diabetes, and tooth decay.”

SSBs are the single largest source of added sugar in the American diet and a primary cause of various health conditions including tooth decay, which affects more than two-thirds of California children (making it the most common chronic childhood disease). The frequency of consumption along with the combination of high levels of sugar and acid make these beverages uniquely damaging to teeth and overall health. Sport, energy and soft drinks are leading to unprecedented levels of decay and loss of tooth enamel for a new generation of youth and young adults. The over-consumption of sugary, acidic drinks is reversing more than 50 years of public health gains realized through preventive measures such as fluoridated water and dental sealants.

Additionally, CDA and the CMA are co-sponsoring a ballot measure for the November 2020 election to establish a statewide two-cent-per-ounce tax on the distribution of SSBs, which would raise at least $2 billion in revenue for critical health programs and reverse a recently passed moratorium on local SSB taxes, preserving the ability of local communities to make their own decisions on combating SSB consumption. 

SB 154: Silver Diamine Fluoride – Sponsor 
CDA is sponsoring SB 154 (Pan) this year to add silver diamine fluoride (SDF) as a Medi-Cal benefit for treatment of dental decay when applied as part of a comprehensive treatment plan. SDF is a topical medication used to slow down or stop cavities in both primary and permanent teeth. The use of SDF is a nonsurgical approach to treating dental decay, as it does not require local anesthetic and can be applied quickly and painlessly. SDF is a colorless liquid that contains both silver and fluoride; although it stains the decayed portion of a tooth, it is becoming more widely used, especially in posterior and primary teeth. In California, Medi-Cal is already using SDF as part of a broader pilot project in 29 counties to manage dental decay in children under 6 years old.

Recent studies of Medicaid expenditures in six states show an average savings of $100 to $350 per child treated with SDF. This could translate to $10 million to $30 million in annual savings for California’s Medi-Cal program. SDF is a proven effective tool worldwide in managing cavities and the serious health problems associated with unmanaged dental decay and is now being shown to provide significant cost savings for public health insurance programs. While SDF may not fully eliminate the need for additional care, it gives Medi-Cal providers a new and effective tool to treat dental decay among the growing Medi-Cal population.

State Office of Oral Health – Proposition 56 Funding
CDA’s Access Plan to reduce barriers to oral health care prioritizes the need for a comprehensive state oral health program led by a state dental director. The state began providing ongoing funding for a dental director and the Office of Oral Health (based in the Department of Public Health) in the 2014-15 budget for the first time in decades, and Jay Kumar, DDS, MPH, was appointed to the position in 2015. Dr. Kumar came to California with more than 25 years of experience in the New York State Bureau of Dental Health, where he also held the position of state dental director and developed the first comprehensive state oral health plan for New York. Dr. Kumar and stakeholders including CDA have developed a state oral health plan that includes several objectives, such as building community-clinical linkages, expanding access to fluoride, dental sealants and screenings, dental coverage, tobacco-use counseling and interventions, and developing programs that promote oral health literacy and healthy habits. This effort received a strong boost from the passage of Prop. 56, which includes an annual $30 million for the state oral health program – a tenfold funding increase and the first time the program has ever had a dedicated revenue source.

For more information contact: Marissa Allen at marissa.allen@cda.org/916.554.7349 or Brianna Pittman at brianna.pittman@cda.org/916.554.7340.

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