Beneficiary Dental Exception(BDE)

Pursuant to Welfare and Institutions Code (WIC) Section 14089.09, the Department of Health Care Services (DHCS) is responsible for processing and reporting Beneficiary Dental Exception requests received for Medi-Cal Dental Managed Care Plan (MCP) members in Sacramento County.

The BDE allows a Dental MCP member to request to opt-out of Dental MCP and move to Fee-For-Service (FFS), if the member is unable to schedule an appointment with a Dental MCP provider. Dental MCP Members can submit BDE requests by mail, fax, email, or calling the BDE phone line (855-347-3310) and a Dental MCP representative will contact the member within three (3) business days to assist the member. Dental MCPs works closely with members to schedule an appropriate appointment within specified time frames and based on the member’s identified needs. If no such appointment is secured, the member will be transferred to Medi-Cal Dental FFS.

If the member does not respond to the initial contact by a Dental MCP representative, the Dental MCP representative will attempt to contact the member one (1) additional time. If the member is nonresponsive to the Dental MCP representative, a letter will be sent to the member to close the case and if the member still wants to continue with the BDE request, he/she can submit a new request.

If the BDE is submitted via the designated BDE phone line, 1-855-347-3310, a DHCS BDE representative will assist the member with submitting a request and coordinate with the Dental MCP to assist the member with getting an appointment with a Dental MCP provider within the appropriate timeframes. The Dental MCP representative can also follow-up with the member to answer any questions or concerns and provide any additional details.

When an appointment is scheduled, the Dental MCP representative will track the BDE case, follow up with the member after the appointment, and inquire about his/her satisfaction with the dental visit. If the appointment was successful and no additional access issues were identified, the BDE case will be closed, indicating no further action is needed.

All "In Progress" BDE cases are case managed until they are closed, including cases with pending initial dental appointments and/or subsequent follow-up appointments.

BDE Reports can be accessed on the Department of Health Care Services website: www.dhcs.ca.gov/services/Pages/BDE-Reporting.aspx