Addressing Denti-Cal Issues for Patients with Special Needs: West Health Comments

Dear Assembly Member Jim Wood,

I am writing on behalf of the Gary and Mary West Health Institute (WHI), a San Diego-based applied medical research organization and part of nonprofit and nonpartisan West Health, which also includes the Gary and Mary West Foundation and the Gary and Mary West Health Policy Center. Our organizations work together toward a shared mission dedicated to lowering the cost of healthcare and enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence.

WHI is the organizational sponsor of Assembly Bill 316 (AB 316), which aims to permanently expand access to dental care for California’s low-income children and adults living with physical, mental, behavioral, or developmental conditions and disabilities. These individuals face greater challenges in accessing appropriate dental care than healthier people, because their dental care often is more complex. Currently, Denti-Cal’s standardized policies and payments, which are based on a healthier population, do not acknowledge the additional costs of caring for individuals with special needs and inhibit providers’ ability to receive proper payment for their care. While the 2018-19 state budget contains funding to supplement payments to reimburse providers for the extra time needed to treat special needs patients under the existing code D9920, this funding requires annual reauthorization as a part of the Prop 56 supplemental payment program. AB 316 instead requires California’s Department of Health Care Services (DHCS) to provide permanent additional funding to reimburse dental providers for the extra time and resources necessary to provide critically-needed oral healthcare for special needs patients.

Appropriately caring for individuals with special needs often requires additional time, multiple visits and other modifications compared to treating healthier people. Many cannot tolerate sitting in a dental chair long enough to receive the services they need because of their disabilities; others require

additional medical screenings at every appointment before they can receive treatments. These factors contribute to additional costs currently not reimbursed under Denti-Cal, limiting the number of dental practices willing to provide oral care for these beneficiaries.

WHI believes your support of AB 316 is critical. Permanent additional reimbursements will give vital financial support to Denti-Cal providers currently serving California’s most vulnerable low-income children and adults and encourages additional dental care providers to treat people with special needs. This legislation is an important step in developing a Denti-Cal system that ensures all individuals have access to high-quality and appropriate dental care.

Sincerely,

Shelley Lyford
President and Chief Executive Officer
West Health Institute
10350 North Torrey Pines Road
La Jolla, CA 92037