Medi‑Cal Dental Managed Care Option to Switch to Medi-Cal Dental Fee‑For‑Service
Sacramento County Medi-Cal Dental Managed Care Plan Parity
As part of the California Advancing and Innovating Medi-Cal (CalAIM) 1915(b) waiver Special Terms and Conditions (STC), the Department of Health Care Services (DHCS) conducted a parity evaluation to assess the performance (utilization) of Sacramento County dental managed care (DMC) plans compared to the statewide dental fee-for-service (FFS) delivery system. The evaluation was based on utilization measures for calendar year 2022 in the following categories: Annual Dental Visits, Preventive Dental Services, and Use of Sealants for children and adults.
Based on the evaluations, DHCS has determined that none of the three DMC plans operating in Sacramento County – Access Dental Plan, Health Net Dental, and Liberty Dental Plan – met parity with statewide FFS utilization averages in all required measures. As a result, members currently enrolled in DMC plans will have the option to enroll in FFS.
Beginning in November 2023, DHCS will send notices to approximately 614,000 members currently enrolled in DMC plans in Sacramento County. The notices will inform affected DMC members of their option to either stay with their current plan or disenroll and join FFS because their current DMC plan did not ensure adequate quality of services. This disenrollment will be effective on December 1, 2023. The notice will provide information on how members can access dental services if they choose FFS or their option to choose an alternate DMC plan only if the member is able to establish an access to care issue in FFS. This notice will be sent only once to currently enrolled DMC plan members in Sacramento County.
Additionally, effective December 1, 2023, newly eligible Medi-Cal members will be enrolled by default into dental FFS. Starting in November 2023, newly eligible Medi-Cal members in Sacramento County will no longer receive a Medi-Cal Choice Packet for DMC enrollment. Newly eligible individuals will instead receive a dental FFS welcome packet containing an insert informing the member of their option to select a DMC plan if the member is able to establish access to care issues within the dental FFS delivery system. The notice will direct members to contact Medi-Cal Dental to determine if an access to care issue exists, and if an access to care issue does exist, a choice packet to enroll in a DMC plan will be sent. The insert will continue to be mailed to newly enrolled members in Sacramento County until DHCS procures for new DMC plans in this county.
To review dental FFS and DMC performance reports, visit the Dental Data Reports webpage.
View and download the resources below to learn more about the option to choose dental FFS in Sacramento County.
Sacramento County Medi-Cal Dental Managed Care Plan Parity Member Questions and Answers
What is changing?
In Sacramento County, beginning on December 1, 2023, you can stay with your DMC plan or receive your dental services via the dental FFS delivery system in Sacramento County. You can only enroll in another DMC plan if you can show that you have had problems accessing care through the FFS delivery system.
Why is this changing?
This change is occurring because your DMC plan failed to meet contract requirements and standards regarding adequate quality of care and services, such as providing the same quality of services offered in the FFS provider network.
How long can I stay in FFS?
You may stay in the dental FFS delivery system until there are new DMC plans available in Sacramento County. If you choose to disenroll from any plan and join the dental FFS delivery system, you will be required to choose a new DMC plan when those plans become available. You will receive a separate notice about when those plans will be available.
Can I stay with my current DMC plan?
Yes. Currently, if you want to stay with your DMC plan, you do not need to do anything.
How can I choose FFS?
If you no longer want to stay with your DMC plan, call Health Care Options (HCO) to choose to receive your dental services via the dental FFS delivery system. You can call HCO Monday through Friday, 8 a.m. to 6 p.m., or visit their website at https://www.healthcareoptions.dhcs.ca.gov/enroll.
Health Care Options:
Can I keep seeing my dentist after December 1, 2023, if I choose FFS?
- If your dentist is part of the dental FFS delivery system, yes, you can keep the same dentist.
- If your dentist is not part of the dental FFS delivery system, you will need to select a new dentist. The Medi-Cal Dental Program can help you find a new dentist in FFS.
How will I know if my dentist is in FFS?
To check if your dentist is in the dental FFS delivery system, call the Medi-Cal Dental Telephone Service Center, Monday through Friday, 8 a.m. to 5 p.m.
Medi-Cal Dental Telephone Service Center:
Tell them that you are currently with a Sacramento DMC plan but want to move to the dental FFS delivery system and would like to keep the same dentist after December 1. They can tell you if your dentist is a dental FFS provider. If your dentist is not a dental FFS provider, they can help you find a new dentist.
Can I choose the dental FFS delivery system if I have a planned dental service or am currently going through a dental procedure?
Yes, you can choose the dental FFS delivery system.
- If you choose the dental FFS delivery system and your dentist is part of FFS, you can continue to stay with your dentist.
- If you choose the dental FFS delivery system and your dentist is not part of FFS, you cannot stay with your dentist. The Medi-Cal Dental program will help you find a new dentist.
Can I choose another DMC plan if I am in a different DMC plan or FFS?
You can choose another DMC plan only if you are enrolled in FFS and cannot get the care you need in FFS.
How do I get dental services after December 1, 2023?
- If you choose to stay with your current DMC plan, you can continue receiving your dental services.
- If you choose to join FFS, contact the Medi-Cal Dental Telephone Service Center at 1-800-322-6384, Monday through Friday, 8 a.m. to 5 p.m. (TTY 1-800-735-2922 or 711). They will help you find a FFS dentist and schedule any dental appointments after December 1, 2023.
You should already have a Medi-Cal Benefits Identification Card (BIC). The BIC is a plastic card with a “poppy flower” or a “blue and white” design. Always take your BIC with you to all dental visits. When you go to the dentist, make sure you show your BIC to the front office. If you need a new BIC, please call your county office: https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx.
You will no longer be able to use the card provided by the Sacramento DMC plan if you choose to leave the plan.
What should I do now?
Choose one of two different ways to receive your dental services:
- Do nothing and keep your current DMC plan.
- Disenroll from your current DMC plan and join the dental FFS delivery system.
What if I have questions?
If you have questions about these changes, please call the Medi-Cal Dental program at 1-800-322-6384, Monday through Friday, 8 a.m. to 5 p.m. (TTY 1-800-735-2922 or 711).
If you have questions about dental plan enrollment or would like to change your DMC plan, call Health Care Options at 800-430-4263 (TTY: 1-800-430-7077 or 711), Monday through Friday, 8 a.m. to 6 p.m. Or go to Health Care Options at https://www.healthcareoptions.dhcs.ca.gov.
Resources for Members
DMC to FFS Parity Insert
DMC to FFS Parity Notification
This is a sample of a letter you will receive by mail on or about November 1, 2023 from the California Department of Health Care Services Medi-Cal Dental Services Division.
DMC to FFS General Flyer
DMC to FFS Q&A Sheet
DMC to FFS Q&A Brochure
Resources for Partners
DMC to FFS General Flyer
DMC to FFS Q&A Sheet
DMC to FFS Q&A Brochure
DMC to FFS Member PowerPoint Presentation
DMC to FFS PowerPoint Presentation for Providers
Social Media Images and Captions
Download DMC to FFS social media images and suggested captions from our social media gallery.