Fixing Denti-Cal


Report #230, April 2016


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dental profession with reimbursement rates among the nation’s lowest, an abundance of restrictive rules and reliance on outdated paper-based administrative processes that compare poorly with the ease of commercial dental insurers.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