Fixing Denti-Cal

Report #230, April 2016
Fixing Denti-Cal

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
April 1, 2016

For Additional Information Contact:
Carole D’Elia, Executive Director
(916) 445-2125

Commission Urges Reboot for Troubled State Denti-Cal Program, Cites Harm to Beneficiaries and and Historic Inability to Reform

California’s Medicaid dental program, Denti-Cal, ranks among state government’s greatest deficiencies, falling disastrously short in providing dental care to a third of California’s population and half of its children, the Little Hoover Commission stated Wednesday in a report calling for a reboot of the historically-challenged program.

The bipartisan citizens commission, in a new report, Fixing Denti-Cal, describes the predicament of 13 million Californians stuck in an underfunded program that has thoroughly alienated the dental profession with reimbursement rates among the nation’s lowest, an abundance of restrictive rules and reliance on outdated paper-based administrative processes that compare poorly with the ease of commercial dental insurers. The Commission reported that many Californians with Denti-Cal benefits struggle to find places to use them – because most dentists want nothing to do with Denti-Cal.

“Denti-Cal’s long-standing inability to reform itself and deliver sufficient care is an unfair and needless condition in the lives of Californians with limited incomes,” said Commission Chair Pedro Nava. “People with state dental benefits deserve a government program that works. Instead, families already struggling to get by in California put up with a dysfunctional program that can’t attract providers and too often lets them down.”

The Commission, after a seven-month review, found that Denti-Cal alone is incapable of stemming a growing – and preventable – epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care. More, the demand for Denti-Cal services continues to rise.

“The Affordable Care Act has brought hope of health coverage for millions without insurance, but the situation with Denti-Cal is only getting worse with three million newcomers added to a program already short of dental providers,” said Chair Nava.

Among major Commission recommendations:

  • The Legislature should set a forceful target in which 66 percent of eligible children use their benefits to make annual dental visits – up from about half currently. This target should drive a wave of innovations that make the state system operate more like commercial insurance and attract more dentists.
     
  • The Department of Health Care Services, which operates Denti-Cal, should cut the red tape to make it easier for dentists to enroll in the program and care for clients.
     
  • The Legislature and Governor should create an evidence-based advisory group of dental and health experts to guide development of Denti-Cal priorities and oversee policy decisions.
     
  • The Legislature and Governor should pass and sign AB 648 (Low) or similar legislation to expand the concept of teledentistry statewide and help to take mobile dental care into schools, clinics and neighborhood settings where people will use their benefits instead of dentists waiting for people to show up at their offices.
     
  • As an epidemic of dental decay among Californians with Denti-Cal coverage is a larger responsibility than the state’s alone, a large, powerful coalition that includes state government, major funders and non-profit organizations should lead a sustained statewide “game changer” to reorient the oral health care system for beneficiaries toward preventative care.
     
  • The Legislature should exercise strong oversight over Denti-Cal’s new targeted financial incentives to dentists who provide preventative care for children and encourage pilot projects that similarly use small targeted financial incentives to boost preventative care for children.
     

“The Commission is encouraged by a wealth of powerful emerging ideas in California and also within Denti-Cal to focus on preventative care and take services to where they are needed,” Commission Chair Nava said. “Fixing Denti-Cal is not about one big solution, but many, to do better by people who have benefits and need places to use them.”

The Little Hoover Commission is an independent state agency charged with recommending ways to improve the efficiency and effectiveness of state programs. The Commission’s recommendations are submitted to the Governor and the Legislature for their consideration and action. The report is available at www.lhc.ca.gov.

Fact Sheet

Study Description

For this study, the Commission examined California’s Denti-Cal program, a Medi-Cal affiliate that provides dental care for low-income Californians, including approximately five million children under 21. This review was requested by Senator and Dr. Richard Pan in an April 6, 2015, request letter to the Commission. Dr. Pan contended that persistent Denti-Cal shortcomings put its beneficiaries at higher risk of dental disease.

The Commission specifically examined the administrative structure of the Denti-Cal program – a division of the California Department of Health Care Services – and explore potential improvements to produce better outcomes for beneficiaries. A December 2014 audit by the California State Auditor reported continuing weaknesses in the program that discourage dentists from participating and discourage parents from taking their children to dentists who do participate. The audit reported that 56 percent of children eligible for dental care through the Denti-Cal program do not go to its participating dentists. This is partly due to having few options, the audit reported. The audit cited five California counties with no participating dentists, 11 counties where participating dentists aren’t taking new patients and 16 counties without enough participating dentists for their populations.

Dental care providers have told the Legislature they avoid participating in the program because the state’s reimbursement rate falls significantly below the cost of providing care. The California State Auditor reported that the state last increased its reimbursement rates in the 2000-01 fiscal year and implemented a 10 percent cut in the rates in September 2013. The Governor and Legislature rescinded the cut in the 2015-16 state budget that went into effect July 1,2015. Nonetheless, dental care providers have said that inadequate reimbursement, when combined with cumbersome state administrative requirements, continues to make participating in the state program unattractive to them as small business operators.

Anecdotal evidence, meanwhile, suggests that some participating dentists perform unnecessary services on Denti-Cal patients to make participation more financially viable. 

Research by health advocates indicates that the dental problems experienced by many low-income California adults and children are largely preventable, and that children with dental problems or missing teeth are more likely to miss school and fall behind their peers in the short term and beyond.

As part of its study, the Commission explored potential improvements to make the Denti-Cal program easier to use and more attractive and viable for providers. It also examined Medicaid dental programs in other states and examined improvements that have reduced so-called “red tape” and increased the number of providers.

Agenda

Overview

In this report, the Commission urges reboot for troubled state Denti-Cal program, and cites its harm to beneficiaries and historic inability to reform.

During its review, the Commission found California’s Medicaid dental program ranks among state government’s greatest deficiencies, falling disastrously short in providing dental care to a third of California’s population and half of its children. Also finds that more than 13 million people eligible for coverage have few places to use their benefits.

The Commission recommends the Legislature set a target in which 66 percent of eligible children use their benefits to make annual dental visits. The Commission also recommends a set of key short- and long-term goals to meet the utilization target.

This review was requested by Senator and Dr. Richard Pan in an April 6, 2015, request letter to the Commission.

Print Agenda
  • October 26
    2017
    Business Meeting
    9:30 a.m., 925 L Street, Room 175, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, October 26, 2017, at 9:30 a.m.
    925 L Street, Room 175
    Sacramento, CA 95814
     

    1. Business Meeting Minutes from September 28, 2017
       
    2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
    3. Closed Session
              PERSONNEL
              The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
       
    4. Subcommittee Reports
      a.  Forest Management – Status update
           – Discussion on Draft Recommendations

      b.  Voter Participation - Status update

      c.  Artificial Intelligence – Status update
       
    5. Commission Survey
       
    6. Project Selection
       
    7. Implementation and Impact Activity
       
    8. Reports from the California State Auditor’s Office
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    October 12, 2017

    For Additional Information Contact:
    Terri Hardy, Deputy Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

    At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

    Following these updates, the Commission will conduct other business as detailed on the agenda.  

    If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

    Video

  • November 19
    2015
    Denti-Cal
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, November 19, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA


    Opening Remarks

    Targeted Rate Increases: Washington State and Alameda County

    1. Laura Smith, President and CEO, Washington Dental Service Foundation (Written Testimony)
       
    2. Dr. Jared Fine, DDS, MPH, Former Dental Health Administrator, Alameda County Public Health Department (Written Testimony)
       

    When There Are No Dentists: Recruiting Pediatricians

    1. Nina Machado, Executive Director, First 5 Amador (Written Testimony)
       
    2. Dr. David J. Stone, Pediatrician, Sutter Amador Pediatrics Center
       
    3. Mindy Epperson, RN Site Supervisor, Sutter Amador Pediatrics Center
       

    Starting Fresh: The Texas Experience

    1. Billy Millwee, Former Texas Medicaid Director, 2009-2012, and Senior Strategic Advisor, Sellers Dorsey (Written Testimony)
       

    An Alternative Option: Federally Qualified Health Centers

    1. Dr. Rosa Arzu, DDS, Dental Director, AltaMed Health Services (Written Testimony)
       
    2. Sean South, Associate Director of Policy & Legislation, California Primary Care Association (Written Testimony)


    Value Over Volume: A Smarter Way Forward

    1. Dr. Paul Glassman, DDS, Professor of Dental Practice and Director of Community Oral Health, University of the Pacific School of Dentistry (Written Testimony)

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    November 5, 2015

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, November 19, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    The November hearing is the Commission’s second look at the Denti-Cal program. The Commission’s first hearing in September focused on the current issues faced by Denti-Cal providers and participants. At this upcoming hearing, the Commission will explore possible solutions and alternatives to the problems currently experienced in the Denti-Cal program.

    At the hearing, the Commission will review several possible solutions or alternatives for Denti-Cal, including: targeted reimbursement increases, a greater emphasis on reaching the underserved in their neighborhoods, the dynamic between funding prevention versus restorative care and ideas for emerging dental technologies. The Commission also will hear testimony about the needs of adults in the Denti-Cal program following the restoration of adult dental coverage in 2014. At the hearing the Commission will first hear from a representative who coordinates Medicaid dental benefits for children in Washington state and a former chief dental administrator from Alameda County’s public health department. The second panel will include representatives from First 5 Amador and Sutter Amador Pediatrics, to discuss local success in increasing dental prevention and care for children. The next speaker will be the former director of the Texas Medicaid program. Another panel will feature the dental director at AltaMed Health Services and an associate director of the California Primary Care Association, who will provide information on Federally Qualified Health Centers (FQHCs). The final speaker will be a dental professor and community oral health director from the University of the Pacific’s dental school.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in in Room 175 at 925 L Street in Sacramento.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.

    Video
  • September 24
    2015
    Denti-Cal
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, September 24, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA


    Opening Remarks

    Why Denti-Cal Needs Reform

    1. Senator Richard Pan, M.D.
       
    2. Assemblymember Jim Wood, DDS
       

    Administrators: Inside California's $1.3 billion Denti-Cal Program

    1. Rene Mollow, Deputy Director of Health Care Benefits and Eligibility, Department of Health Care Services (Written Testimony)
       
    2. Joe Ruiz, Vice President of State Government Programs, Delta Dental of California (Written Testimony)


    The Dental Establishment: Why Denti-Cal Isn't Working Better

    1. Dr. John Blake, Executive Director, Children's Dental Health Clinic (Written Testimony)
       
    2. Brianna Pittman, Legislative Director, California Dental Association (Written Testimony)
      Nicette Short, Director of Public Policy, California Dental Association 

    The Stakeholder Perspective: How Children Pay the Price

    1. Jenny Kattlove, Senior Director, Programs, The Children's Partnership (Written Testimony)
      ​​​​​​​

    The State Dental Director: Building a Plan to Reduce Disparities

    1. Dr. Jayanth V. Kumar, DDS, M.P.H., California State Dental Director, Department of Public Health (Written Testimony)
      ​​​​​​​ 

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    September 21, 2015 

    For Additional Information Contact: 
    Carole D'Elia, Executive Director
    (916) 445-2125

    Notice of Meeting
    (Revised Witness List and Additional Business Meeting Locations Added)

    On Thursday, September 24, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients.  The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    As part of this review, the Commission will examine the administrative workings of the Denti-Cal program and hear from advocates for improving Denti-Cal outcomes.  The Commission also will examine impacts on Denti-Cal patients due to low dental provider participation rates and consider ideas to attract more providers and broaden the availability of care. 

    At the hearing the Commission will hear from two state legislators who will discuss their reasons for asking the Little Hoover Commission to review the Denti-Cal program.  The Commission also will hear from a panel of representatives from the Department of Health Care Services and Delta Dental of California, who will discuss the current administration of the Denti-Cal program.  Another panel will include representatives from the California Dental Association and the Children’s Dental Health Clinic, who will offer the dental provider perspective on Denti-Cal.  Another panel will feature a senior director of the Children’s Partnership, a nonprofit child advocacy organization.  She will speak about how current Denti-Cal difficulties directly impact children in California.  The final panel will feature California’s new State Dental Director, who will describe how the California Department of Public Health is building a plan to reduce oral health disparities among California populations.

    There will be an opportunity for public comment at the end of the hearing.  The Commission also encourages written comments.  Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.  Additional teleconference locations accessible to the public for the meeting are: 41608 Indian Trail, Ste. 1, Rancho Mirage, CA; 12456 Ventura Blvd., Ste. 1, Studio City, CA; and 300 Corporate Pointe, Ste. 380, Culver City, CA.  

    Following the business meeting, the Californians’ Interactions with Government study subcommittee will meet to discuss next steps for the project.  All public notices for meetings are on the Commission’s website, www.lhc.ca.gov.  If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.  

    Video
October 26
2017
Business Meeting
9:30 a.m., 925 L Street, Room 175, Sacramento, CA
Business Meeting
Agenda

AGENDA

Business Meeting
Thursday, October 26, 2017, at 9:30 a.m.
925 L Street, Room 175
Sacramento, CA 95814
 

  1. Business Meeting Minutes from September 28, 2017
     
  2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
  3. Closed Session
            PERSONNEL
            The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
     
  4. Subcommittee Reports
    a.  Forest Management – Status update
         – Discussion on Draft Recommendations

    b.  Voter Participation - Status update

    c.  Artificial Intelligence – Status update
     
  5. Commission Survey
     
  6. Project Selection
     
  7. Implementation and Impact Activity
     
  8. Reports from the California State Auditor’s Office
Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
October 12, 2017

For Additional Information Contact:
Terri Hardy, Deputy Executive Director
(916) 445-2125

Notice of Meeting

On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

Following these updates, the Commission will conduct other business as detailed on the agenda.  

If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

Video

November 19
2015
Denti-Cal
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Denti-Cal
Thursday, November 19, 2015, at 9:00 a.m.
State Capitol, Room 437
Sacramento, CA


Opening Remarks

Targeted Rate Increases: Washington State and Alameda County

  1. Laura Smith, President and CEO, Washington Dental Service Foundation (Written Testimony)
     
  2. Dr. Jared Fine, DDS, MPH, Former Dental Health Administrator, Alameda County Public Health Department (Written Testimony)
     

When There Are No Dentists: Recruiting Pediatricians

  1. Nina Machado, Executive Director, First 5 Amador (Written Testimony)
     
  2. Dr. David J. Stone, Pediatrician, Sutter Amador Pediatrics Center
     
  3. Mindy Epperson, RN Site Supervisor, Sutter Amador Pediatrics Center
     

Starting Fresh: The Texas Experience

  1. Billy Millwee, Former Texas Medicaid Director, 2009-2012, and Senior Strategic Advisor, Sellers Dorsey (Written Testimony)
     

An Alternative Option: Federally Qualified Health Centers

  1. Dr. Rosa Arzu, DDS, Dental Director, AltaMed Health Services (Written Testimony)
     
  2. Sean South, Associate Director of Policy & Legislation, California Primary Care Association (Written Testimony)


Value Over Volume: A Smarter Way Forward

  1. Dr. Paul Glassman, DDS, Professor of Dental Practice and Director of Community Oral Health, University of the Pacific School of Dentistry (Written Testimony)

Comments Submitted by Members of the Public

Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
November 5, 2015

For Additional Information Contact:
Carole D’Elia, Executive Director
(916) 445-2125

Notice of Meeting

On Thursday, November 19, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

The November hearing is the Commission’s second look at the Denti-Cal program. The Commission’s first hearing in September focused on the current issues faced by Denti-Cal providers and participants. At this upcoming hearing, the Commission will explore possible solutions and alternatives to the problems currently experienced in the Denti-Cal program.

At the hearing, the Commission will review several possible solutions or alternatives for Denti-Cal, including: targeted reimbursement increases, a greater emphasis on reaching the underserved in their neighborhoods, the dynamic between funding prevention versus restorative care and ideas for emerging dental technologies. The Commission also will hear testimony about the needs of adults in the Denti-Cal program following the restoration of adult dental coverage in 2014. At the hearing the Commission will first hear from a representative who coordinates Medicaid dental benefits for children in Washington state and a former chief dental administrator from Alameda County’s public health department. The second panel will include representatives from First 5 Amador and Sutter Amador Pediatrics, to discuss local success in increasing dental prevention and care for children. The next speaker will be the former director of the Texas Medicaid program. Another panel will feature the dental director at AltaMed Health Services and an associate director of the California Primary Care Association, who will provide information on Federally Qualified Health Centers (FQHCs). The final speaker will be a dental professor and community oral health director from the University of the Pacific’s dental school.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in in Room 175 at 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.

Video
September 24
2015
Denti-Cal
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Denti-Cal
Thursday, September 24, 2015, at 9:00 a.m.
State Capitol, Room 437
Sacramento, CA


Opening Remarks

Why Denti-Cal Needs Reform

  1. Senator Richard Pan, M.D.
     
  2. Assemblymember Jim Wood, DDS
     

Administrators: Inside California's $1.3 billion Denti-Cal Program

  1. Rene Mollow, Deputy Director of Health Care Benefits and Eligibility, Department of Health Care Services (Written Testimony)
     
  2. Joe Ruiz, Vice President of State Government Programs, Delta Dental of California (Written Testimony)


The Dental Establishment: Why Denti-Cal Isn't Working Better

  1. Dr. John Blake, Executive Director, Children's Dental Health Clinic (Written Testimony)
     
  2. Brianna Pittman, Legislative Director, California Dental Association (Written Testimony)
    Nicette Short, Director of Public Policy, California Dental Association 

The Stakeholder Perspective: How Children Pay the Price

  1. Jenny Kattlove, Senior Director, Programs, The Children's Partnership (Written Testimony)
    ​​​​​​​

The State Dental Director: Building a Plan to Reduce Disparities

  1. Dr. Jayanth V. Kumar, DDS, M.P.H., California State Dental Director, Department of Public Health (Written Testimony)
    ​​​​​​​ 

Comments Submitted by Members of the Public

Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
September 21, 2015 

For Additional Information Contact: 
Carole D'Elia, Executive Director
(916) 445-2125

Notice of Meeting
(Revised Witness List and Additional Business Meeting Locations Added)

On Thursday, September 24, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients.  The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

As part of this review, the Commission will examine the administrative workings of the Denti-Cal program and hear from advocates for improving Denti-Cal outcomes.  The Commission also will examine impacts on Denti-Cal patients due to low dental provider participation rates and consider ideas to attract more providers and broaden the availability of care. 

At the hearing the Commission will hear from two state legislators who will discuss their reasons for asking the Little Hoover Commission to review the Denti-Cal program.  The Commission also will hear from a panel of representatives from the Department of Health Care Services and Delta Dental of California, who will discuss the current administration of the Denti-Cal program.  Another panel will include representatives from the California Dental Association and the Children’s Dental Health Clinic, who will offer the dental provider perspective on Denti-Cal.  Another panel will feature a senior director of the Children’s Partnership, a nonprofit child advocacy organization.  She will speak about how current Denti-Cal difficulties directly impact children in California.  The final panel will feature California’s new State Dental Director, who will describe how the California Department of Public Health is building a plan to reduce oral health disparities among California populations.

There will be an opportunity for public comment at the end of the hearing.  The Commission also encourages written comments.  Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.  Additional teleconference locations accessible to the public for the meeting are: 41608 Indian Trail, Ste. 1, Rancho Mirage, CA; 12456 Ventura Blvd., Ste. 1, Studio City, CA; and 300 Corporate Pointe, Ste. 380, Culver City, CA.  

Following the business meeting, the Californians’ Interactions with Government study subcommittee will meet to discuss next steps for the project.  All public notices for meetings are on the Commission’s website, www.lhc.ca.gov.  If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.  

Video
Print Agenda
  • October 26
    2017
    Business Meeting
    9:30 a.m., 925 L Street, Room 175, Sacramento, CA
    Business Meeting
    Agenda

    AGENDA

    Business Meeting
    Thursday, October 26, 2017, at 9:30 a.m.
    925 L Street, Room 175
    Sacramento, CA 95814
     

    1. Business Meeting Minutes from September 28, 2017
       
    2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
    3. Closed Session
              PERSONNEL
              The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
       
    4. Subcommittee Reports
      a.  Forest Management – Status update
           – Discussion on Draft Recommendations

      b.  Voter Participation - Status update

      c.  Artificial Intelligence – Status update
       
    5. Commission Survey
       
    6. Project Selection
       
    7. Implementation and Impact Activity
       
    8. Reports from the California State Auditor’s Office
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    October 12, 2017

    For Additional Information Contact:
    Terri Hardy, Deputy Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

    At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

    Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

    The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

    Following these updates, the Commission will conduct other business as detailed on the agenda.  

    If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

    Video

  • November 19
    2015
    Denti-Cal
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, November 19, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA


    Opening Remarks

    Targeted Rate Increases: Washington State and Alameda County

    1. Laura Smith, President and CEO, Washington Dental Service Foundation (Written Testimony)
       
    2. Dr. Jared Fine, DDS, MPH, Former Dental Health Administrator, Alameda County Public Health Department (Written Testimony)
       

    When There Are No Dentists: Recruiting Pediatricians

    1. Nina Machado, Executive Director, First 5 Amador (Written Testimony)
       
    2. Dr. David J. Stone, Pediatrician, Sutter Amador Pediatrics Center
       
    3. Mindy Epperson, RN Site Supervisor, Sutter Amador Pediatrics Center
       

    Starting Fresh: The Texas Experience

    1. Billy Millwee, Former Texas Medicaid Director, 2009-2012, and Senior Strategic Advisor, Sellers Dorsey (Written Testimony)
       

    An Alternative Option: Federally Qualified Health Centers

    1. Dr. Rosa Arzu, DDS, Dental Director, AltaMed Health Services (Written Testimony)
       
    2. Sean South, Associate Director of Policy & Legislation, California Primary Care Association (Written Testimony)


    Value Over Volume: A Smarter Way Forward

    1. Dr. Paul Glassman, DDS, Professor of Dental Practice and Director of Community Oral Health, University of the Pacific School of Dentistry (Written Testimony)

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    November 5, 2015

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, November 19, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    The November hearing is the Commission’s second look at the Denti-Cal program. The Commission’s first hearing in September focused on the current issues faced by Denti-Cal providers and participants. At this upcoming hearing, the Commission will explore possible solutions and alternatives to the problems currently experienced in the Denti-Cal program.

    At the hearing, the Commission will review several possible solutions or alternatives for Denti-Cal, including: targeted reimbursement increases, a greater emphasis on reaching the underserved in their neighborhoods, the dynamic between funding prevention versus restorative care and ideas for emerging dental technologies. The Commission also will hear testimony about the needs of adults in the Denti-Cal program following the restoration of adult dental coverage in 2014. At the hearing the Commission will first hear from a representative who coordinates Medicaid dental benefits for children in Washington state and a former chief dental administrator from Alameda County’s public health department. The second panel will include representatives from First 5 Amador and Sutter Amador Pediatrics, to discuss local success in increasing dental prevention and care for children. The next speaker will be the former director of the Texas Medicaid program. Another panel will feature the dental director at AltaMed Health Services and an associate director of the California Primary Care Association, who will provide information on Federally Qualified Health Centers (FQHCs). The final speaker will be a dental professor and community oral health director from the University of the Pacific’s dental school.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in in Room 175 at 925 L Street in Sacramento.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.

    Video
  • September 24
    2015
    Denti-Cal
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Denti-Cal
    Thursday, September 24, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA


    Opening Remarks

    Why Denti-Cal Needs Reform

    1. Senator Richard Pan, M.D.
       
    2. Assemblymember Jim Wood, DDS
       

    Administrators: Inside California's $1.3 billion Denti-Cal Program

    1. Rene Mollow, Deputy Director of Health Care Benefits and Eligibility, Department of Health Care Services (Written Testimony)
       
    2. Joe Ruiz, Vice President of State Government Programs, Delta Dental of California (Written Testimony)


    The Dental Establishment: Why Denti-Cal Isn't Working Better

    1. Dr. John Blake, Executive Director, Children's Dental Health Clinic (Written Testimony)
       
    2. Brianna Pittman, Legislative Director, California Dental Association (Written Testimony)
      Nicette Short, Director of Public Policy, California Dental Association 

    The Stakeholder Perspective: How Children Pay the Price

    1. Jenny Kattlove, Senior Director, Programs, The Children's Partnership (Written Testimony)
      ​​​​​​​

    The State Dental Director: Building a Plan to Reduce Disparities

    1. Dr. Jayanth V. Kumar, DDS, M.P.H., California State Dental Director, Department of Public Health (Written Testimony)
      ​​​​​​​ 

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    September 21, 2015 

    For Additional Information Contact: 
    Carole D'Elia, Executive Director
    (916) 445-2125

    Notice of Meeting
    (Revised Witness List and Additional Business Meeting Locations Added)

    On Thursday, September 24, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients.  The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    As part of this review, the Commission will examine the administrative workings of the Denti-Cal program and hear from advocates for improving Denti-Cal outcomes.  The Commission also will examine impacts on Denti-Cal patients due to low dental provider participation rates and consider ideas to attract more providers and broaden the availability of care. 

    At the hearing the Commission will hear from two state legislators who will discuss their reasons for asking the Little Hoover Commission to review the Denti-Cal program.  The Commission also will hear from a panel of representatives from the Department of Health Care Services and Delta Dental of California, who will discuss the current administration of the Denti-Cal program.  Another panel will include representatives from the California Dental Association and the Children’s Dental Health Clinic, who will offer the dental provider perspective on Denti-Cal.  Another panel will feature a senior director of the Children’s Partnership, a nonprofit child advocacy organization.  She will speak about how current Denti-Cal difficulties directly impact children in California.  The final panel will feature California’s new State Dental Director, who will describe how the California Department of Public Health is building a plan to reduce oral health disparities among California populations.

    There will be an opportunity for public comment at the end of the hearing.  The Commission also encourages written comments.  Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.  Additional teleconference locations accessible to the public for the meeting are: 41608 Indian Trail, Ste. 1, Rancho Mirage, CA; 12456 Ventura Blvd., Ste. 1, Studio City, CA; and 300 Corporate Pointe, Ste. 380, Culver City, CA.  

    Following the business meeting, the Californians’ Interactions with Government study subcommittee will meet to discuss next steps for the project.  All public notices for meetings are on the Commission’s website, www.lhc.ca.gov.  If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.  

    Video
October 26
2017
Business Meeting
9:30 a.m., 925 L Street, Room 175, Sacramento, CA
Business Meeting
Agenda

AGENDA

Business Meeting
Thursday, October 26, 2017, at 9:30 a.m.
925 L Street, Room 175
Sacramento, CA 95814
 

  1. Business Meeting Minutes from September 28, 2017
     
  2. Presentation from Jennifer Kent, Director, Department of Health Care Services (Written Testimony)
  3. Closed Session
            PERSONNEL
            The Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).
     
  4. Subcommittee Reports
    a.  Forest Management – Status update
         – Discussion on Draft Recommendations

    b.  Voter Participation - Status update

    c.  Artificial Intelligence – Status update
     
  5. Commission Survey
     
  6. Project Selection
     
  7. Implementation and Impact Activity
     
  8. Reports from the California State Auditor’s Office
Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
October 12, 2017

For Additional Information Contact:
Terri Hardy, Deputy Executive Director
(916) 445-2125

Notice of Meeting

On Thursday, October 26, 2017, the Little Hoover Commission will conduct a business meeting to hear an update on a prior Commission report and study and conduct regularly scheduled activities.  The meeting will begin at 9:30 a.m. in Conference Room 175 located on the first floor of 925 L Street in Sacramento. 

At the meeting, the Commission will hear from Jennifer Kent, director of the California Department of Health Care Services, who will provide an implementation update on the recommendations from the Commission’s April 2016 report, Fixing Denti-Cal.  The Commission will learn about the department’s progress in achieving a 60 percent utilization goal for children and efforts to streamline and automate enrollment for dentists.

Following this discussion, the Commission will meet in closed session to discuss personnel matters consistent with Government Code section 11126, subdivision (a)(1).  The Commission will then reconvene in open session and publically announce any actions taken in closed session consistent with Government Code section 11126.3, subdivision(f).

The Commission will then discuss the potential recommendations for its forest management study.  The Commission will also receive status updates on two ongoing studies on voter participation and artificial intelligence.

Following these updates, the Commission will conduct other business as detailed on the agenda.  

If you need reasonable accommodation due to a disability, please contact Commission Deputy Executive Director Terri Hardy at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, October 19, 2017.

Video

November 19
2015
Denti-Cal
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Denti-Cal
Thursday, November 19, 2015, at 9:00 a.m.
State Capitol, Room 437
Sacramento, CA


Opening Remarks

Targeted Rate Increases: Washington State and Alameda County

  1. Laura Smith, President and CEO, Washington Dental Service Foundation (Written Testimony)
     
  2. Dr. Jared Fine, DDS, MPH, Former Dental Health Administrator, Alameda County Public Health Department (Written Testimony)
     

When There Are No Dentists: Recruiting Pediatricians

  1. Nina Machado, Executive Director, First 5 Amador (Written Testimony)
     
  2. Dr. David J. Stone, Pediatrician, Sutter Amador Pediatrics Center
     
  3. Mindy Epperson, RN Site Supervisor, Sutter Amador Pediatrics Center
     

Starting Fresh: The Texas Experience

  1. Billy Millwee, Former Texas Medicaid Director, 2009-2012, and Senior Strategic Advisor, Sellers Dorsey (Written Testimony)
     

An Alternative Option: Federally Qualified Health Centers

  1. Dr. Rosa Arzu, DDS, Dental Director, AltaMed Health Services (Written Testimony)
     
  2. Sean South, Associate Director of Policy & Legislation, California Primary Care Association (Written Testimony)


Value Over Volume: A Smarter Way Forward

  1. Dr. Paul Glassman, DDS, Professor of Dental Practice and Director of Community Oral Health, University of the Pacific School of Dentistry (Written Testimony)

Comments Submitted by Members of the Public

Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
November 5, 2015

For Additional Information Contact:
Carole D’Elia, Executive Director
(916) 445-2125

Notice of Meeting

On Thursday, November 19, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

The November hearing is the Commission’s second look at the Denti-Cal program. The Commission’s first hearing in September focused on the current issues faced by Denti-Cal providers and participants. At this upcoming hearing, the Commission will explore possible solutions and alternatives to the problems currently experienced in the Denti-Cal program.

At the hearing, the Commission will review several possible solutions or alternatives for Denti-Cal, including: targeted reimbursement increases, a greater emphasis on reaching the underserved in their neighborhoods, the dynamic between funding prevention versus restorative care and ideas for emerging dental technologies. The Commission also will hear testimony about the needs of adults in the Denti-Cal program following the restoration of adult dental coverage in 2014. At the hearing the Commission will first hear from a representative who coordinates Medicaid dental benefits for children in Washington state and a former chief dental administrator from Alameda County’s public health department. The second panel will include representatives from First 5 Amador and Sutter Amador Pediatrics, to discuss local success in increasing dental prevention and care for children. The next speaker will be the former director of the Texas Medicaid program. Another panel will feature the dental director at AltaMed Health Services and an associate director of the California Primary Care Association, who will provide information on Federally Qualified Health Centers (FQHCs). The final speaker will be a dental professor and community oral health director from the University of the Pacific’s dental school.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in in Room 175 at 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.

Video
September 24
2015
Denti-Cal
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Denti-Cal
Thursday, September 24, 2015, at 9:00 a.m.
State Capitol, Room 437
Sacramento, CA


Opening Remarks

Why Denti-Cal Needs Reform

  1. Senator Richard Pan, M.D.
     
  2. Assemblymember Jim Wood, DDS
     

Administrators: Inside California's $1.3 billion Denti-Cal Program

  1. Rene Mollow, Deputy Director of Health Care Benefits and Eligibility, Department of Health Care Services (Written Testimony)
     
  2. Joe Ruiz, Vice President of State Government Programs, Delta Dental of California (Written Testimony)


The Dental Establishment: Why Denti-Cal Isn't Working Better

  1. Dr. John Blake, Executive Director, Children's Dental Health Clinic (Written Testimony)
     
  2. Brianna Pittman, Legislative Director, California Dental Association (Written Testimony)
    Nicette Short, Director of Public Policy, California Dental Association 

The Stakeholder Perspective: How Children Pay the Price

  1. Jenny Kattlove, Senior Director, Programs, The Children's Partnership (Written Testimony)
    ​​​​​​​

The State Dental Director: Building a Plan to Reduce Disparities

  1. Dr. Jayanth V. Kumar, DDS, M.P.H., California State Dental Director, Department of Public Health (Written Testimony)
    ​​​​​​​ 

Comments Submitted by Members of the Public

Public Notice

PUBLIC NOTICE

FOR IMMEDIATE RELEASE
September 21, 2015 

For Additional Information Contact: 
Carole D'Elia, Executive Director
(916) 445-2125

Notice of Meeting
(Revised Witness List and Additional Business Meeting Locations Added)

On Thursday, September 24, 2015, the Little Hoover Commission will conduct a public hearing on Denti-Cal, the program that provides dental care for Medi-Cal recipients.  The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

As part of this review, the Commission will examine the administrative workings of the Denti-Cal program and hear from advocates for improving Denti-Cal outcomes.  The Commission also will examine impacts on Denti-Cal patients due to low dental provider participation rates and consider ideas to attract more providers and broaden the availability of care. 

At the hearing the Commission will hear from two state legislators who will discuss their reasons for asking the Little Hoover Commission to review the Denti-Cal program.  The Commission also will hear from a panel of representatives from the Department of Health Care Services and Delta Dental of California, who will discuss the current administration of the Denti-Cal program.  Another panel will include representatives from the California Dental Association and the Children’s Dental Health Clinic, who will offer the dental provider perspective on Denti-Cal.  Another panel will feature a senior director of the Children’s Partnership, a nonprofit child advocacy organization.  She will speak about how current Denti-Cal difficulties directly impact children in California.  The final panel will feature California’s new State Dental Director, who will describe how the California Department of Public Health is building a plan to reduce oral health disparities among California populations.

There will be an opportunity for public comment at the end of the hearing.  The Commission also encourages written comments.  Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.  Additional teleconference locations accessible to the public for the meeting are: 41608 Indian Trail, Ste. 1, Rancho Mirage, CA; 12456 Ventura Blvd., Ste. 1, Studio City, CA; and 300 Corporate Pointe, Ste. 380, Culver City, CA.  

Following the business meeting, the Californians’ Interactions with Government study subcommittee will meet to discuss next steps for the project.  All public notices for meetings are on the Commission’s website, www.lhc.ca.gov.  If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, September 17, 2015.  

Video