You can walk away
Managed care is voluntary. If you do nothing you stay in ordinary fee-for-service Medi-Cal Dental. If you join a plan and dislike it, ordinary Medi-Cal is still there.
About this project
We explain how Medi-Cal dental managed care actually works, who runs it, who owns them, and what the State already knows about how it is going. The jokes here are ours. The facts belong to whoever filed them, and we link to every one.
Start here
A dental plan you did not choose, explained
Most of California gets its Medi-Cal dental care through fee-for-service, where you pick a dentist who takes Medi-Cal and go. Two counties out of fifty-eight do it differently. There, the State hands your dental benefit to a managed care company, and you pick from a short list.
In Los Angeles that list is optional. In Sacramento it is not.
This site sets out who the three companies are, who owns them, who actually answers when you call, and what the regulator has already written down about them. It is not a campaign and it is not advice. It is the reading nobody should have to do.
Scope
Why this is mostly about Sacramento
Dental managed care runs in two counties. Only one of them locks the door behind you.
You cannot
Enrollment is mandatory, with few exceptions. Eligible members must select one of three plans, and if they do not select one, the State selects for them.
Nobody in Sacramento asked for this. It arrived as state policy in 1995, when DHCS set up dental managed care, in its own words, to explore how effective it would be as a way of delivering dental services. Thirty-one years later it covers two counties out of fifty-eight, and the exploring appears to be ongoing.
The difference in one line
A member in Los Angeles who is unhappy with their plan can leave it. A member in Sacramento can complain about it.
The part that surprises people
None of this is a secret
The State is not unaware of how these plans perform. It has written it down, more than once, in documents anyone can download.
This change is occurring because your DMC plan failed to meet contract requirements and standards regarding adequate quality of care and services, such as providing the same quality of services offered in the FFS provider network.
Then there is the routine paperwork. DHCS audits each plan, issues findings, takes a corrective action plan in reply, and audits again the following year to see whether the fix took. Sometimes it did not.
Findings denoted as repeat findings are uncorrected deficiencies, substantially similar to those identified in the previous audit.
Read those two together. The State told Sacramento members their plan had fallen short of the contract, let them leave for eighteen months, then closed the door and signed new contracts running to roughly the middle of 2030. Along the way its own auditors recorded a deficiency that was still there a year later, and the deficiency was about failing to explain things to members clearly.
Our opinion, clearly labeled
Where we stand
Everything above is sourced. This part is what we think about it, kept separate on purpose.
We are not neutral about this arrangement and will not pretend to be.
Three companies hold these contracts. Two are owned by publicly traded corporations. The third is majority owned by a private equity firm, with a competing insurer holding forty percent of its parent. None of them is a charity and none of them claims to be. A company's first legal duty runs to its owners, which is not a scandal, it is company law, and you can read it in their own filings.
Our objection is narrower than that. A Sacramento member cannot take their business elsewhere. They were placed here, the State has already found in writing that the plans fell short, and a deficiency found in one audit can still be sitting there in the next one. Where there is no exit, the standard ought to be higher, not lower.
Instead the enforcement runs on findings, corrective action plans and a follow-up audit twelve months later. That is a sensible way to manage a supplier. It is a poor way to help someone with an abscess and no way out of the plan that is slow-walking them.
We also know that almost nobody in this program is going to dig a contract term out of a shareholder filing. They are working, caring for somebody, or trying to get a tooth looked at before it gets worse. That is the entire reason the digging happens here instead.
Standards
How we work
The satire is in the name and the logo. It stops at the evidence.
Primary sources only
Plan handbooks, provider manuals, regulator audits, court and securities filings. If a claim rests on a summary of a document rather than the document, it does not go up.
Quote it and link it
Where we say a company or an agency said something, we quote the words and link the file, so you never have to take our word for the characterization.
Name what we cannot confirm
Pages carry an open questions section. Things we suspect but cannot document live there, phrased as questions, until a document settles them.
Keep opinion in its own box
Where we are arguing rather than reporting, it is labeled, as on this page. You should always be able to tell which one you are reading.
Disclosure
Two sites, one project
We also run NoSuchProvider.org. It is the same people, and we would rather you heard that from us.
This site
I Can't Smile, California
Covers
Dental managed care
How the program works, who runs each plan, who owns them, and what the contracts and audits say. Sacramento and Los Angeles.
Companion site
NoSuchProvider.org
Covers
Ghost networks and enforcement
Directory investigations, phantom specialists and enforcement actions across California health plans, dental and medical.
Dental is the smaller of the two problems and much the easier to check, which is exactly why it deserves its own site. A directory listing seven prosthodontists can be tested by one person with a phone and a public registry. That is harder to do across an entire medical network.
Where this site mentions ghost networks or enforcement and you want the working, we send you there. Where that site covers dental managed care and you want the map, it sends you here. Neither site treats the other as a source: whichever one makes a claim carries the document behind it.
Housekeeping
Things we are not
- Not the State of California. Not DHCS, not Medi-Cal, not the Smile, California campaign, and not connected to any of them. The name and the logo are a joke at their expense, which is legal, and clearly labeled, which is polite.
- Not a dental plan. We cannot see your file, fix your coverage, book your appointment or overturn your denial. Nobody here has access to anything of yours.
- Not lawyers, dentists or your advocate. Nothing here is legal, dental or benefits advice.
- Not paid by anyone. No plan, agency, vendor or law firm funds this site or reviews it before publication.
If you need help with your own benefits today, call Medi-Cal Dental at 1-800-322-6384, or Health Care Options at 1-800-430-4263 to change plans. Those are the real numbers and they are not ours.
Corrections
We will get things wrong. When we do we would rather hear it from you than from a lawyer, and rather fix it than defend it.
Tell us what is wrong and, if you can, point at the document. Corrections are made on the page itself with a note saying what changed and when. We do not quietly edit and move on.
If you are one of the companies covered here and think we have been unfair, the same route applies, and we will publish your reply alongside the correction.
Been through it yourself?
Denials, ghost dentists, months on a waiting list, a plan that changed without telling you. The documents show the shape of it. Members show what it costs.