Medi-Cal Dental Program

Denti-Cal is one of the services currently provided in the state of California as part of the Medi-Cal health insurance program. Denti-Cal Program beneficiaries will receive free or low-cost dental care. Denti-Cal services are available for eligible children and adults who reside in the state. The Denti-Cal eligibility requirements are the same as those for Medi-Cal and you can automatically enroll in Denti-Cal once you qualify for Medi-Cal. If your income is higher than the Medi-Cal limits for the size of your family, then you will be required to pay a certain amount of the cost for the month in which you have dental services.

Discover comprehensive information about California’s Denti-Cal Program in our comprehensive guide here.

Denti-Cal Coverage for Children in California

Denti-Cal requires early and periodic screening for Medi-Cal beneficiaries younger than 21 years of age. This is a special Denti-Cal coverage for children, known as Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services. Basic EPSDT Denti-Cal services include restoration of teeth, maintenance of dental health and relief of pain and infections.

The Medi-Cal dental program covers diagnostic, preventative and treatment services. Depending on the type of Denti-Cal coverage youths have, such as full scope or limited scope, covered procedures can consist of oral evaluations, exams, fluoride treatments and root canals. Beneficiaries can lose eligibility for dental services they once received upon reaching a certain age. Those with partial coverage may only be able to receive emergency dental services. However, most California children 20 years of age and younger enrolled in Medi-Cal have full-scope dental services. Unlike adults, the Denti-Cal Program will not limit the dental services based on funds used annually.

Find out how children enrolled in Denti-Cal may be able to get braces in our detailed California guide.

Denti-Cal Services for Adults in California

California is one of the few states to offer Denti-Cal services to adults, residents 21 years of age and older. However, Denti-Cal coverage for adults is more limited than services available for minors. The Denti-Cal Program imposes an annual limit on funds available for dental health care. When adult petitioners apply for Medicaid in California, they receive benefit enrollment information detailing the copay of services if they qualified from share of costs (SOC).

Some of the Denti-Cal full scope benefits for adults currently include exams, fluoride treatments, restorative services and dentures. Enrolled pregnant women have additional dental services covered by Denti-Cal, which continue for a short duration after delivery. For some patients, Denti-Cal coverage extends for special circumstances, determined on a case-by-case basis.

Learn more about annual limits and covered services from Denti-Cal by downloading our guide.

Denti-Cal Program Costs for California Enrollees

Even if you are eligible for Denti-Cal services, you may have to pay part of the cost of your dental care. The Denti-Cal Program can implement copays on certain services, which you are responsible for paying. Denti-Cal copays are often very affordable, as the Medicaid dental plan is available for low-income families. If there is any copayment, the dentist will collect it at your appointment.

Some Denti-Cal enrollees are subject to SOC. If your income is higher than the threshold, the Denti-Cal Program requires you to pay a portion of dental expenses before the state pays the remaining amount. The monthly SOC amount varies based on household income. Enrollees should keep in mind that SOC requirements only occur in months when dental services are rendered. For example, if you receive dental treatments in two separate months, you will need to pay your fixed SOC payment for each month. However, if you have two dental appointments in the same month, you only need to pay the one-month SOC minimum. You may also incur dental charges if you receive services not covered by the Medicaid program in California.

Using Denti-Cal Benefits in California

Once you enroll in Denti-Cal, you can schedule an appointment with a dental provider within the program. You can choose any Denti-Cal dentist registered to provide Medi-Cal dental services. If you need assistance finding an approved Denti-Cal provider, you can speak to program representatives who will locate the closest available office. Denti-Cal will not pay for your treatment if you go to a dentist who is not enrolled in Medi-Cal. There are no limits to how many times you may change your dentist, though visiting the same dentist can make it easy for you and your family to make appointments for regular visits and for you to get reminders when you are due for a check-up. A regular dentist will also be familiar with your dental history and will be able to help you find specialist treatment if you need it. If you should decide to change your dentist in the middle of a treatment, then you should write a letter to request the change and give it to your new dentist to send to Denti-Cal.

What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.

Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.