Innovations to the Medi-Cal Dental program continue to improve the experience of Medi-Cal providers and Medi-Cal patients. Among other improvements made this year, the Department of Health Care Services created online care coordination to connect patients and providers and expanded the type of children’s presumptive eligibility providers to include Medi-Cal dental providers.
Dedicated care coordinator services representatives make care more accessible
The online care coordination referral form released in 2024 continues to streamline the administrative processes of Medi-Cal Dental delivery. Coordination of patient care creates continuity of care — and the online form makes coordination services more accessible. The new form and streamlined processes can assist with:
- Scheduling timely dental visits.
- Connecting a patient with the appropriate provider, whether a specialist or general dentist.
- Coordinating transportation or interpreter services for the patients.
Community health workers, dentists, local oral health programs, school nurses and other individuals can complete the form.
Having dedicated Medi-Cal dental care coordination representatives ensures that patients are connected to providers who will provide exceptional dental care services. Medi-Cal beneficiaries and their representative or a provider have two ways to access care coordination services:
- Complete the new online Care Coordination Referral Form. Once the form is completed and submitted, the care coordination representative will contact the beneficiary or their representative to coordinate care.
- Contact care coordination representatives by calling 800.322.6384 Monday through Friday from 8 a.m. to 5 p.m.
More information about the care coordination services is available through the April 2024 edition of the Medi-Cal Dental Provider Bulletin.
How to participate in the children’s presumptive eligibility program
Medi-Cal dentists are now able to participate in children’s presumptive eligibility, also known as CPE. Effective for services on or after Aug. 5, 2024, providers can enroll eligible children into temporary full-scope Medi-Cal coverage online.
When a provider submits a CPE for a patient, the patient will receive a Medi-Cal eligibility determination in real time, and a contingent approval notice can be printed. Patients are potentially eligible for CPE if they are under the age of 19, a California resident, not a current Medi-Cal recipient, within the income limits for their household size, and have not exceeded two presumptive eligibility enrollment periods in the last 12 months.
Providers interested in participating in the CPE program will need to complete the following steps to become a qualified provider:
- Register and create a login on the Medi-Cal Learning Portal. When completing registration, the “type of users” field must be a health care provider or provider staff.
- Complete the CPE Computer-Based Training. Providers must ensure that all staff who will assist applicants with CPE enrollment complete the required trainings as well.
- Complete the provider agreement in the Medi-Cal Provider Portal. To complete this process, dental providers will need to call the Medi-Cal telephone service center at 800.541.5555 to receive a one-time registration token that they will use to start their electronic registration from the provider login page. (This is different from the regular dental provider portal).
Medi-Cal dentists who have questions about this process can contact Medi-Cal by phone at 800.541.5555 or by email. Learn more about children’s presumptive eligibility on the Medi-Cal Providers webpage.