Nursing homes and Medi–Cal have important roles in ensuring that residents receive needed dental services in a timely manner.
Nursing homes must address residents’ dental needs in their careplans and must assist residents in obtaining routine and emergency dental care. Nursing homes can arrange services by hiring a dentist or by having an agreement with a dentist to treat residents. If a resident’s dentures are lost or damaged, the nursing home is required to make a prompt referral to a dentist and to aggressively work at replacing the dentures.
Through its Denti–Cal program, Medi–Cal covers emergency dental care, diagnostic services, necessary treatments, extractions and other dental treatment, subject to specific restrictions. Beneficiaries must obtain services from a dentist enrolled in Medi–Cal. Medi–Cal provides information on its dental program to beneficiaries through its call–in center at 800–322–6384 and on its website at: www.denti–cal.ca.gov. Medi–Cal’s dental coverage regulation is found at Title 22, California Code of Regulations, §51307.
At press time, Governor Schwarzenegger had recommended elimination of Medi–Cal’s dental benefit, but the Legislature had not made final budget decisions. If dental services are eliminated, nursing home residents on Medi–Cal have another means to purchase to dental care if they have a share–of–cost.
Federal law and a California lawsuit settlement (Johnson v Rank) give nursing home residents on Medi–Cal the right to keep income needed to pay for medical costs not covered by Medi–Cal, including necessary dental care. You must first obtain a physician’s order for the dental services and have this order included in your nursing home careplan. Arrange the dental care from any dentist, present a copy of the bill to the nursing home and deduct the bill from your monthly share–of–cost set by Medi–Cal.