California to Eliminate Much Needed Oral Healthcare for the Elderly, Homebound, and Those with Special Needs

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CDHA Calls on Governor and Legislature to stop damaging policy that prevents care to homebound, elderly, and those in nursing facilities provided by the Registered Dental Hygienist in Alternative Practice.

It is wrong for the department to deny care to these patients through this harmful policy.

The California Dental Hygienists’ Association (CDHA) is calling for action by the California State Legislature and the Governor to stop Denti-Cal’s harmful new policy. The Department of Health Care Services (DHCS) implemented a new Denti-Cal policy July 20th for dental hygiene treatment provided by independent hygienists (Registered Dental Hygienists in Alternative Practice, RDHAP’s). According to the CDHA, this policy harms the patients and the RDHAPs who provide the treatment.

“Patients who are homebound, in skilled nursing facilities, or in intermediate care facilities, cannot tolerate treatment the way it is provided in a dental office due to their physical and/or cognitive disabilities,” states CDHA President Julie Coan, RDH, MPH. “RDHAP’s are trained specifically to provide care to these patients in a manner that they can tolerate, often at their bedside.”

When the California Legislature enacted legislation in 1998 (AB 560, Chapter 753, Statutes of 1997) to create RDHAPs who could provide treatment outside the dental office, services were never intended to be provided in the same manner as in the dental office, because of patient limitations. The California Office of Statewide Health Planning & Development (OSHPD) Health Manpower Pilot Projects #139 and #155 ( revealed that these trained and educated RDHAP’s provide dental hygiene treatment just as safely and effectively as it is provided in a dental office.

Coan continues, “The new policy harms patients by delaying care and denying needed treatment. Since the policy was implemented in July, CDHA knows of no requests submitted by ANY RDHAP that have been approved. In fact, one Fresno based RDHAP has submitted over 20 requests for treatment, yet NONE have been approved by the department. This denial by the state is impacting our most vulnerable populations.”

“Medical standards require that after the initial scaling and root planning hygiene treatment, a periodontal maintenance treatment every three months is provided for patients who have periodontal disease. Other hygiene treatments cannot be substituted for periodontal maintenance,” states Coan.

CDHA leadership argues that cutting the periodontal maintenance reimbursement to less than half of what it was, means it now costs the RDHAP to provide the treatment. RDHAPs will not be able to provide the care to those patients who truly need the care the most. Denti-Cal reimbursement rates were already approximately 1/3 lower than the rates paid by private insurance.

“For over 20 years, RDHAPs have provided these dental hygiene treatments safely and effectively,” adds CDHA President Julie Coan. “It’s wrong for the department to deny care to these patients now through this bureaucratic and harmful policy.”

**The California Dental Hygienists’ Association (CDHA) is the authoritative voice of the state’s dental hygiene profession. The organization was established over 30 years ago when two regional associations merged to form a unified professional group. CDHA represents thousands of dental hygienists in the state of California.

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