Sacramento County

Medi‑Cal Dental Managed Care Option to Switch to Medi-Cal Dental Fee‑For‑Service

Dental Managed Care Option to Switch to Dental Fee-For-Service

About

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.