Medi-Cal managed care plans (MCPs) are critical to promoting children’s oral health. The California Advancing and Innovating Medi-Cal (CalAIM) initiative and new Medi-Cal benefits available to children and families present new opportunities for MCPs, local oral health programs (LOHPs), community-based organizations (CBOs), schools, and local First 5s to build and strengthen relationships that promote optimal oral health for California’s children and youth.
Opportunity
Existing legislation and contracts already require that Medi-Cal MCPs cover and ensure dental screenings and oral health assessments for all their members. Specifically, MCPs must ensure initial and periodic dental screenings/oral health assessments for all children and youth, as well as assist with referrals to appropriate Medi-Cal dental providers.
Recommendation
LOHPs should engage with local MCPs to establish partnerships to advance children’s oral health. Below are suggestions for how LOHPs can leverage plan requirements and new benefits in the Medi-Cal program to partner with MCPs and other local organizations.
- Meet with your local Medi-Cal MCPs by finding the plan(s) available in your county here: https://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx. Contact your local managed care plan’s CalAIM or Population Health Management point of contact to explore partnerships.
- Identify potential areas of collaboration to improve children’s access to care and advance mutual oral health goals. MCPs must meet requirements to screen and refer children to oral health care. The table on page 3 of the Toolkit provides a non-exhaustive list of Medi-Cal benefits and plan requirements that can be leveraged to advance oral health screenings and integration across various systems and entities.
Based on the questions from the February 7, 2024, Project Directors Meeting (PDM) and additional emails we received following the PDM, Children Now has compiled a list of suggestions and corresponding questions that LOHPs could ask of the Medi-Cal MCPs in their county and recommendations on what LOHPs could ask for in the memoranda of understanding that MCPs are developing with local health jurisdictions. The highlighted sections are intended for LOHPs to customize.
