You can go to the dentist during COVID-19. To keep everyone safe, your dental visit will look a little different. Your dental office may ask if you want to schedule a video appointment. When you go to your dental office for an appointment, you may have your temperature taken. You may be asked to wear a face-covering and to keep six feet between yourself and others in the waiting room.
Learn more about returning to the dentist during COVID-19.
Watch this video to learn about what your next dental appointment may look like.
The Medi‑Cal Dental Program offers free or low-cost dental benefits for enrolled Medi‑Cal members. If your income is more than the Medi‑Cal limit for your family size, a low-cost monthly premium may be required. Learn more about the Medi-Cal Dental Program.
The Medi‑Cal program offers a variety of benefits to members including covered dental services. To receive dental coverage through Medi‑Cal, you must be Medi‑Cal eligible. Your eligibility determines the types of benefits you have access to through Medi‑Cal. You do not need to apply separately for dental coverage because it is a part of the Medi‑Cal program.
For information on how to apply for Medi‑Cal, you can go to www.coveredca.com, view a list of county offices, or call 1‑800‑300‑1506.
View a list of the dental services you qualify for.
Learn more about your covered dental services.
Medi‑Cal Dental covers dental services for most Medi‑Cal members. Depending on your income and your family size, dental services may be available at no cost to you (or your child). In some cases, you may have to pay a “Share of Cost (SOC)” and/or a co-pay.
Medi‑Cal Dental covers many services to help keep your gums and teeth strong and healthy. Learn more about services covered by the Medi‑Cal Dental Program.
In some cases, you may have to pay a Share of Cost (SOC) and/or a co-pay as a Medi‑Cal member. SOC is determined by your monthly income. If you have been told that you have a SOC, this likely means your income is more than the Medi‑Cal limit for your family size, and you have to pay a monthly dollar amount for your medical expenses. Contact Medi‑Cal at 1‑800‑541‑5555 to find out what your share of the cost is. Learn more about SOC.
Your co‑pay is a fixed amount you pay for a service, usually at the same time you receive the service. The co‑pay usually falls outside your covered dental services. The co-pay amount will vary based on the type of service. For example, a dental visit might have a co-pay of $2. The co‑pay for an emergency room visit will usually cost more. For some services, you may have a co-pay and a SOC. These services may have a co‑pay for adults with the Medi‑Cal dental benefit:
You can find a dentist by visiting the Medi‑Cal Dental provider website, or you can call the Telephone Service Center Phone Line at 1‑800‑322‑6384.
As Medi‑Cal member, you can ask to see another dentist or specialist before making a decision about your primary dentist’s treatment plan for you. This is also an option for you if you are enrolled in a Dental Managed Care plan.
Medi‑Cal provides non-emergency and non-medical transportation services to eligible members. You can qualify for transportation if your appointment is medically necessary. To request transportation assistance, call the Telephone Service Center Phone Line at 1‑800‑322‑6384. The transportation must be used only for necessary health care covered by the Medi-Cal program. Call your county social services office for help if you need a ride to your appointment, but you do not qualify for medically necessary non-emergency transportation services.
Medi-Cal provides language interpretation assistance and American Sign Language (ASL) translation services to Medi-Cal members at no cost. Language interpreters are available in over 250 languages and dialects. You, or your dental office can call the Telephone Service Center (TSC) at 1‑800‑322‑6384 Monday through Friday, between 8 a.m. and 5 p.m. to ask for language assistance over the telephone during your dental appointment. Language assistance cannot be scheduled ahead of time. If you are a member with hearing or speaking limitations, you can call the Teletext Typewriter (TTY) line at 1‑800‑735‑2922, Monday through Friday, 8 a.m. to 5 p.m.; at all other times, you should call the California Relay Service TDD/TTY at 711 for help. For assistance scheduling ASL translation services during your dental appointment, please have the operator call the toll-free member line at 1‑800‑322‑6384.
Show your Medi‑Cal Benefits Identification Card (BIC) to your dentist’s office at your appointment. Your dentist will match the name and signature on your BIC with another form of identification, such as:
In some cases, you can still be seen for dental services without a BIC. If your dentist does not know you, they must make a good faith effort to verify your identity.
It is important to show up to your dental appointments, but if you know you will not be able to make it, call your dentist at least 24 hours before to cancel and reschedule. Missing a dental appointment can have a big impact on the health of your mouth. It is best to make all arrangements (transportation, babysitting, time off work) when you schedule your appointment to make sure you can keep it.
You may obtain a copy of your x-rays or records from your dentist; however, your dentist may charge you a reasonable fee for their reproduction.
If services were prior authorized to one dentist and you wish to change your dentists, it is necessary that you write a letter indicating your change and have your new dentist submit that letter to the Medi-Cal Dental Program with his/her Treatment Authorization (TAR) form. The Medi-Cal Dental Program will contact your previous dentist to verify if any of the prior authorized services have been performed and will issue a new Notice of Authorization (NOA) as applicable.
If you are denied services that your dentist has requested prior authorization for, please contact your dentist to determine if a re-evaluation of the request could be made. You may also file a request through the Department of Social Services for a Fair Hearing by calling toll-free (800) 952-5253. You may also write to: The Department of Social Services State Hearings Division P.O. Box 944243 MS 19-37 Sacramento, CA 94244-2430 To expedite your request, please include the Document Control Number (DCN). The DCN references the denied services.
The American Dental Association recognizes these examples as dental emergencies:
If you have dental pain or a dental emergency, contact your dental office for treatment. If you do not have a regular dentist or your dental office is closed, call the Medi-Cal Dental Telephone Service Center at 1‑800‑322‑6384, for help finding one. You can also get free transportation if there are no dental offices open in your area.
You should make an appointment for your child’s first dental visit as soon as their first tooth comes in or by their first birthday, whichever comes first. Many kids get cavities as early as age 2. See the dentist as soon as possible to prevent problems.
If you are under the age of 21, you are covered for free or low-cost check-ups twice a year. If you are 21 or over, you are covered for free or low-cost check-ups once a year. Regular dental visits are important for your oral health and your overall health.
It is safe and important to see the dentist while pregnant. When you are pregnant, your oral health is a big part of making sure your baby is healthy.
Learn more about oral health care and pregnancy.
Watch this video to learn more about visiting the dentist while pregnant.
If you have restricted scope Medi-Cal, sometimes called “emergency Medi-Cal” you may qualify for Medi-Cal coverage for emergency and pregnancy-related services. Learn more about your Medi-Cal eligibility.
If you live in Sacramento County, you will need to enroll in Dental Managed Care (DMC) and will see a dentist through a dental managed care plan. If you live in Los Angeles County, you can choose to stay in Medi‑Cal Dental or you can enroll in DMC. If you enroll in DMC, the plan you choose will send you information about your benefits. Learn more about Dental Managed Care (DMC).
Call MAXIMUS, the State’s Health Care Options Contractor at toll-free (800) 430-4263.
If you or your child are under 21 years old, Medi-Cal covers preventive services, such as regular health check-ups and screenings to check for any problems with your medical, dental, vision, hearing, mental health, and any substance use disorders. You can also get vaccinations to keep you healthy. Medi-Cal covers screening services any time there is a need for them, even if it is not during your regular check-up. Medically necessary services are covered under EPSDT. For more details, view the Information for Medi-Cal Beneficiaries (EPSDT) document.
An Authorized Representative is someone you can name and give access to your Protected Health Information (PHI). An Authorized Representative can be family members, friends, or any other individual you choose. For example, you may want your spouse or adult child to help with billing questions, booking appointments, or to be aware of your health status. See our Member Authorized Representative Frequently Asked Questions for more information.
If you did not receive your BIC or it is lost or stolen, you may ask for a BIC from your county social services office. If your BIC is stolen, you must tell your local police and your county social services office. You should give as much information about the theft as possible. If you are issued a new card, your old card will no longer be valid. Please contact your local county office.
If you have applied for, have received, or are currently receiving benefits/services from Medi-Cal AND you have a complaint about how your benefits/services are/were handled, or your services have been denied or modified, you may:
You must file your request within 90 days of receiving the Notice of Action (NOA). You may be able to file after 90 days if you have a good reason, like illness or a disability.
* DHCS received federal Section 1135 approval to temporarily extend the 90 days to up to an additional 120, for a total of up to 210 days after the date of this notice. This temporary extension is effective March 1, 2020 and will terminate upon termination of the public health emergency.
* = An extension in the time that a member has to file for a Fair Hearing has been granted via the 1135 waiver because of the COVID-19 public health emergency.
Your benefits will continue pending review (Aid Paid Pending) if the hearing is filed within 10 days of receiving the NOA. This process allows you to continue receiving services while the case is being reviewed.
Requesting a state hearing:
You may complete the “Request for State Hearing” on the back of the NOA. Please provide all requested information such as your full name, address, telephone number, the name of the county that took the action against you, the aid program(s) involved, and a detailed reason why you want a hearing. If you have trouble understanding English, be sure to tell us your language (and dialect) so we can arrange for you to have language assistance at the hearing. If you have chosen an authorized representative, be sure to tell us his/her name and address. Please try to write as neatly as possible. If you wish, you may attach a letter to explain why you believe the county action is not correct. It is always a good idea to keep a copy of your hearing request. For more information, please visit the page on Your Hearing Rights.
Then you may submit your request one of these ways:
OR
You can make a toll-free call to request a State Hearing. Please note—due to a high volume of calls, phone lines are very busy.
California Department of Social Services
Public Inquiry and Response
Phone (800) 743-8525 (Voice)
(800) 952-8349 (TDD)
NOTE: The State Hearings Division cannot accept requests for a State Hearing via e-mail.
For additional information, visit the State Hearings Requests with the Department of Social Services.
You have the right to inspect, review, and receive a copy of your personal health information (PHI). You must be the individual, or the parent, guardian, or personal representative of the individual for whom you seek documentation. To request copies of your PHI documents, please see the Privacy Forms page or use the link below to download the request form.
The Medi-Cal Program provides medical services to qualified beneficiaries in California through managed care health plans that contract with the Department Health Care Services (DHCS) or individual providers on a fee-for-service (FFS) basis. With a few exceptions, Medi-Cal beneficiaries are required to enroll in a managed care plan for their health care services. Beneficiaries that have pre-existing complex medical conditions and are currently undergoing an active course of medical treatment from a FFS provider can request a temporary medical exemption (MER) from managed care enrollment by submitting HCO Form 7101. DHCS reviews all documentation submitted with a MER and approves or denies all MERs, in accordance with Title 22, California Code of Regulations, Section 53887.
Members have the right to examine all documents DHCS considers to determine whether a MER should be granted or denied. Members can contact DHCS to request their documentation or ask questions about their MER or the MER process. To request documents related to a medical exemption request, please visit the Medical Exemption Request Documentation page.
If you think discrimination has affected your benefits or services, you may file a discrimination complaint with the DHCS Office of Civil Rights below:
Office of Civil Rights
Department of Health Care Services
P. O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Phone: (916) 440-7370
Email: CivilRights@dhcs.ca.gov.
You may use the ADA Title VI Discrimination Complaint form to submit your complaint to DHCS Office of Civil Rights. The form also contains additional information about your rights. A complaint should be filed as soon as possible or within 180 days of the last act of discrimination. If your complaint involves matters that occurred longer ago than this and you are requesting a waiver of the time limit, you will be asked to show good cause why you did not file your complaint within the 180-day period.
You may also submit a discrimination complaint to United States Department of Health and Human Services, Office of Civil Rights. Additional information on filing discrimination complaints is available on the Non-Discrimination Policy and Language Access webpage.