Common Questions

What Is the Medi‑Cal Dental Program?

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.

Do I qualify for Medi‑Cal dental services?

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.

How do I apply for Medi‑Cal to get dental services?

For information on how to apply for Medi‑Cal, you can visit the Department of Health Care Services website, go to www.coveredca.com, view a list of county offices, or  call 1‑800‑300‑1506.

Is it harder for me to receive my green card if I receive Medi-Cal?

No, unless you live in a long-term care facility (like a nursing home) and Medi-Cal is covering the costs of your residency.

What dental services am I covered for?

View a list of the dental services you qualify for.

Learn more about your covered dental services.

If I am signed up, do I have to pay for 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.

What does the Medi‑Cal Dental Program pay for?

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.

What is a Share of Cost (SOC)?

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.

What is a Co‑Pay?

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:

• Non-emergency services provided in an emergency room – Co‑pay $5
• Outpatient services – Co‑pay $1

Can I get a copy of my x-rays and records from my dentist?

You may obtain a copy of your x-rays or records from your dentist, but your dentist may charge you a reasonable fee for their reproduction.

How do I find a Medi-Cal dentist?

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.

What if I want a second opinion?

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.

If I do not have a ride, are there other options to get to the dentist’s office?

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.

What if I need an interpreter during my dental appointment?

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.

What do I need to bring to my dental appointment?

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:

• Your Social Security Number (SSN)
• A valid California driver’s license
• Any identification card issued by the Department of Motor Vehicles (DMV)
• Or any other document which appears to prove your identity

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.

What happens if I miss an appointment?

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.

Can I get a copy of my x-rays and records from my dentist?

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

Can I change dentists in the middle of treatment?

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.

What if I am denied services requested for prior authorization?

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.

Non-Medical Transportation (NMT)

One type is called non-medical transportation (NMT). If you can travel by car, bus, train, or taxi, but do not have a ride to your appointment, NMT services can be set up. You can also use NMT if you need to pick up prescriptions, medical supplies, or equipment. For help with an NMT ride, follow the steps below:

• If you are enrolled in a health plan, call the plan’s Member Services for help with NMT services.
• If you are enrolled in a Medi-Cal Dental Managed Care (DMC) plan, call your DMC plan for help with NMT services.
• If you have trouble getting a ride from a health plan or DMC plan, call the Telephone Service Center at 1-800-322-6384. Your county Medi-Cal office may also be able to help you get an NMT ride.

Need more information about approved NMT providers? You can access the list on the Department of Health Care Services website.

Non-Emergency Medical Transportation (NEMT)

The other type of ride is called non-emergency medical transportation (NEMT). Medi-Cal offers NEMT services to eligible members based on a medical need. Your medical or dental provider can decide if you need NEMT services. NEMT services cover these rides:

• Wheelchair vans
• Litter vans
• Ambulances
• Air transportation

You should ask for a ride as soon as you can before your scheduled appointment. If you have or will have many upcoming appointments, your medical or dental provider can ask for advance transportation to cover future appointments. For help with a NEMT ride, follow the steps below:

• If you are enrolled in a DMC plan, call your Member Services for help with NEMT services. You will need a prescription from a licensed provider.
• If you have Fee-For-Service Medi-Cal, please let your provider know and they will help you get the NEMT ride or call the Medi-Cal San Diego Field Office at 1-858-495-3666.

What do I need to bring to my dental visit?

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:

• Your Social Security Number (SSN)
• A valid California driver’s license
• Any identification card issued by the Department of Motor Vehicles (DMV)
• Or any other document which appears to prove your identity

If your photo ID has expired, the dental office will accept it up to six months from the expiration date.

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.

What happens if I miss an appointment?

It is important to show up to your dental appointments. 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 plan ahead (transportation, babysitting, time off work) when you make your appointment to make sure you can keep it.

What if I need an interpreter during my dental appointment?

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.

What is a dental emergency?

The American Dental Association recognizes these examples as dental emergencies:

• Bleeding that doesn’t stop
• Painful swelling in or around your mouth
• Severe pain
• Facial trauma, such as injury to jawbone and face
• Gum infection with pain or swelling
• After surgery treatment (dressing change, stitch removal)
• Broken or knocked-out tooth
• Snipping or adjusting wires in braces that hurt your cheeks or gums

A routine dental visit is not an emergency. This includes:

• Regular visits for exams, cleanings and x-rays
• Regular visit for braces
• Removal of teeth that aren’t painful
• Treatment of cavities that aren’t painful
• Teeth whitening

When should my child have their first dental appointment?

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.

Learn more about your child’s first dental visit. 

How often should I go to the dentist?

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.

Is it safe to go to the dentist while I’m pregnant?

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.

What if I only have restricted scope Medi-Cal?

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.

What is the difference between Medi-Cal Dental (Fee-For-Service) and Dental Managed Care (Sacramento County and Los Angeles County)?

The Medi-Cal Dental Program is made up of two delivery systems: Medi-Cal Dental (Fee-For-Service) and Dental Managed Care (Sacramento County and Los Angeles County). Fee-For-Service is a way Medi-Cal pays doctors and other health care providers. Medi-Cal Dental Fee-For-Service is the program in most California counties. Dental Managed Care (DMC) is an organized system to help you get high-quality care and stay healthy. If you live in Sacramento County you will be enrolled in DMC. As a DMC member you will be assigned to a dental provider in your DMC plan’s network. If you live in Los Angeles County you can choose to enroll in DMC or stay in Medi-Cal Dental. If you enroll in DMC the plan you choose will send you a dental card and your benefit information. Please visit the Dental Managed Care Members webpage for information about DMC.

How can I get information about my benefits if I have a dental managed care plan?

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).

I am currently enrolled in a prepaid health plan/managed care plan; how do I change plans?

Call MAXIMUS, the State’s Health Care Options Contractor at toll-free (800) 430-4263.

State Hearing Process

If treatment your dental provider requested has been denied or changed, if you are not happy with the outcome of your complaint, or your Conlan refund request was denied (see Cost of Dental Services section in the Member Handbook), you may request a State Hearing through the California Department of Social Services (CDSS). Your local County Social Services office can assist you with this request. You can find a complete list of county offices on the Department of Health Care Services website here.

You can represent yourself at the State Hearing. A friend, lawyer, or any other person can also represent you. You are responsible for making the arrangements if you want someone else to represent you. To get free legal help, call the Public Inquiry and Response Unit of CDSS at 1-800-952-5253. This unit can also help with general information about the State Hearing process.

Requesting a State Hearing will not affect your eligibility for dental services. You will not be penalized for asking for a hearing. We will maintain confidentiality during the entire complaint process.

Legal Help

You may be able to get free legal help. Call the California Department of Consumer Affairs at 1-800-952-5210, or TTY 1-800-326-2297. You may also call the local Legal Aid Society in your county at 1-888-804-3536.

When do I ask for a State Hearing?

If you disagree with the Notice of Medi-Cal Dental Action you received, you should first discuss different treatment plans with your dental provider to get the best care that is covered by the Medi-Cal Dental Program. If you and your dental provider agree that a different treatment plan is not an option, you have 90 days after the date on that notice to request a State Hearing.

How do I start the process?

You can start the process by calling toll-free 1-800-952-5253 or by creating an account.

You may send a copy of the entire Notice of Medi-Cal Dental Action or write to:

California Department of Social Services State Hearings Division
P.O. Box 944243 MS 9-17-37
Sacramento, CA 94244-2430

If you are calling or writing to request a State Hearing, be sure to include the Document Control Number (DCN) located on your Notice of Medi-Cal Dental Action. The DCN identifies the Treatment Authorization Request that the services were denied on. Including the DCN helps speed up processing your request. If you are calling or writing to request a State Hearing because you are dissatisfied with the result of your complaint case, be sure to include the Service Form identification included on your denial letter.

Accessing Your Personal Health Information

You have the right to review and get 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 members 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 members are required to enroll in a managed care plan for their health care services. Members 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 state regulations.

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.

Filing a Discrimination Complaint

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.