Medi-Cal recipients and providers alike don’t necessarily know that Medi-Cal benefits include dental benefits; even fewer are aware that pregnant women have exclusive oral health preventive benefits.
Through a First 5 LA, Policy and Advocacy grant, Maternal and Child Health Access (MCHA) spearheaded the Oral Health Advocacy for Pregnant Women and Children project (see below). Our findings and experiences are shared in this BRIEF. We invite you to read this information since more than half (53%) of births in LA County are covered by Medi-Cal. (Statewide, the figure is about 47%.) This information is valuable and necessary for those who work with pregnant women.
Educate and Advocate: Oral Health During Pregnancy for Low-Income Women in California”, highlights the multiple factors and barriers resulting in few low-income pregnant women accessing oral health care benefits. The brief discusses two important pieces of information that are the center of the issue of oral health during pregnancy:
• Medi-Cal benefits include dental benefits and;
• Pregnant women can safely access oral health services during any trimester of pregnancy.
Because this information is not widely known, most low-income women go through their pregnancy without an oral health examination to even assess what may be needed, much less receive any treatment, and many are in pain from needed oral health services. Barriers such as an insufficient number of providers willing to treat pregnant women; complicated billing processes, low reimbursement rates; and pregnant women fearful of treatment, including x-rays, contribute to low numbers of pregnant women accessing oral health care.
The brief also calls out MCHA’s advocacy win – that women with pregnancy-only Medi-Cal are included in the partial restoration of adult dental effective, May 1, 2014. (See the Denti-Cal Bulletin Vol 30, #8, May, 2014.) Note that the sentence about “medical necessity’ is misplaced and not meant to apply to pregnant women differently than all other adults. A clarification will be issued.
Take Action We invite you to read the BRIEF in its entirety and join us in advocating for more comprehensive dental benefits for pregnant women. Please note upcoming Dental Stakeholder meetings (usually the second Thursday bi-monthly), resources (brochures and posters) and coming soon, videos from our first-ever oral health during pregnancy conference in Los Angeles.
Maternal and Child Health Access began working on expanding access to dental care for pregnant women in 2001, based on the growing evidence of a link between periodontal disease and both low birth weight and premature birth and due to the limitations of benefits for women with “pregnancy-related” Medi-Cal only. Preventive dental benefits were expanded in 2001 for women in four of the Medi-Cal aid codes most used by pregnant women.
On October 7, 2005, SB 377 (Ortiz) was signed into law, requiring the immediate implementation of 10 preventive dental benefits for ALL pregnant women with “limited scope,” or “full scope” Medi-Cal including women with “Presumptive Eligibility” (PE) Medi-Cal. Since then, Denti-Cal has issued updates through bulletins available on their website (see link below). Benefits for pregnant and post-partum women have been increased to 21 ( See the Denti-Cal provider bulletin, May 2010, Issue 26, Vol 11). In addition, adult pregnant women are eligible for Federally Required Adult Dental Services (FRADS) and/or emergency services.
The Need is Great
In Los Angeles County, dental disease makes up one of the largest health care needs: in 2006, over 50% of pregnant women in Los Angeles had oral health problems during pregnancy; yet, over 30% of them did not see a dentist. Studies have shown a link among gum disease in pregnant women, low birth weight in newborns, and premature deliveries, the leading cause of death in the first month of life. Hence, dental care during pregnancy is critical. However, too often oral health care during pregnancy is underutilized for fear of harm to the fetus. For women covered by Medi-Cal, oral health care is even harder to obtain during pregnancy because of the difficulty in finding a provider that both is willing to treat pregnant women and accepts Medi-Cal insurance.
Resources are Available
Despite recent cuts, pregnant and postpartum women with Medi-Cal (Dental benefits known as Denti-Cal) continue to be eligible for pregnancy-related services and services for conditions that might complicate the pregnancy. Dental providers are understandably confused about which reimbursable services may be provided for pregnant women. See the chart to the left for further information or contact us.
The Oral Health Advocacy Project is a partnership between Maternal and Child Health Access and the Community Clinic Association of Los Angeles County. The project is funded by a First 5 LA’s Community Opportunities Fund Grant and California Hospital Medical Center’s Community Grant.
The Oral Health project addresses policy and programmatic barriers that impede access and provision of oral health services, focusing on increasing 1) access to appropriate oral health care resources and 2) utilization of preventive and therapeutic dental health services for pregnant women and children in Los Angeles County.
Goals of the Oral Health Advocacy Project
- Provide outreach and technical assistance to low-income pregnant women and dental providers who accept Medi-Cal.
- Gather and analyze available data related to access barriers and utilization of dental services.
- Monitor preventive dental benefits for low-income and other pregnant women, particularly given upcoming health reform changes.
- Improve access to needed oral health benefits for low income children and pregnant women.
For more information, feel free to contact: Monica Ochoa, Oral Health Advocacy Coordinator at firstname.lastname@example.org or (213) 749-4261 ext. 360.