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.

• 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

Medi-Cal Adult Dental Benefits

Upon federal approval, adult dental benefits will change on January 1, 2018. Dental
benefits will not change for pregnant women or adults in a skilled nursing or
intermediate care facility. Children’s dental benefits will not change.

You have these services now:
• Exams and x-rays
• Cleanings (prophylaxis)
• Fluoride treatments
• Fillings
• Root canals in front teeth
• Prefabricated crowns
• Full dentures
• Other medically necessary dental services

Services to be added include:
• More types of exams
• Deep cleanings (scaling and root planing)
• Laboratory crowns
• Partial dentures
• Root canals in back teeth

If shown to be medically necessary, dental services can go over the yearly $1800 limit.
For questions or to find a dentist

• Call Denti-Cal at 1-800-322-6384. Or go to www.dentical.ca.gov.
• In Sacramento, call your plan:
o Access Dental: 1-877-821-3234
o Health Net Dental: 1-877-550-3868
o Liberty Dental: 1-877-550-3875
• In Los Angeles county, you can also call these numbers:
o Access Dental: 1-888-414-4110
o Health Net Dental: 1-800-977-7307
o Liberty Dental: 1-888-703-6999