Medi-Cal Dental Member Frequently Asked Questions (FAQs)
Click on a FAQ link below to see the response.
For assistance on finding dentists who accept new patients for the Medi-Cal Dental Program, you may call toll-free (800) 322-6384, Monday through Friday, 8:00 a.m. to 5:00 p.m.
Services that are included in the Medi-Cal Dental Program’s scope of benefits are not chargeable to the Medi-Cal dental member. However, you are responsible for any Share of Cost amount. You are also responsible for the benefits available under the Medi-Cal Dental Program that duplicate those provided under any other contractual or legal entitlements you are receiving.
If your income is more than the Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your Share of Cost (SOC). When you pay or promise to pay that amount, your SOC amount is considered met. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical and dental bills for that month.
For example, if your SOC is $50 and your medical bills for services covered by Medi-Cal for that month are $500, you must pay $50. You have then met your SOC and Medi-Cal will pay the remaining $450. You may satisfy your SOC amount through any medical provider such as your doctor, dentist, pharmacy, or optometrist.
You may obtain a copy of your x-rays or records from your dentist; however, your dentist may charge you a reasonable fee for their reproduction.
To contact the Medi-Cal Dental Program, please call the Member Telephone Service Center at (800) 322-6384. The call is free. Medi-Cal dental program representatives are available 8:00 a.m. to 5:00 p.m., Monday through Friday to assist you.
To check on your eligibility for Medi-Cal benefits, please contact your County Social Services office, listed in your local telephone book.
Please contact your local County Social Services office, listed in your local telephone book.
Call MAXIMUS, the State’s Health Care Options Contractor at toll-free (800) 430-4263.
If services were prior authorized to one dentist and you wish to change your dentists, it is necessary that you write a letter indicating your change and have your new dentist submit that letter to the Medi-Cal Dental Program with his/her Treatment Authorization (TAR) form. The Medi-Cal Dental Program will contact your previous dentist to verify if any of the prior authorized services have been performed and will issue a new Notice of Authorization (NOA) as applicable.
If you are denied services that your dentist has requested prior authorization for, please contact your dentist to determine if a re-evaluation of the request could be made. You may also file a request through the Department of Social Services for a Fair Hearing by calling toll-free (800) 952-5253. You may also write to:
The Department of Social Services
State Hearings Division
P.O. Box 944243 MS 19-37
Sacramento, CA 94244-2430
To expedite your request, please include the Document Control Number (DCN). The DCN references the denied services.
If you or your child are under 21 years old, Medi-Cal covers preventive services, such as regular health check-ups and screenings. Regular checkups and screenings look for any problems with your medical, dental, vision, hearing, and mental health, and any substance use disorders. You can also get vaccinations to keep you healthy. Medi-Cal covers screening services any time there is a need for them, even if it is not during your regular check-up. All of these services are at no cost to you.
For details, please view the Information for Medi-Cal Members (EPSDT) document.
