# Dental Managed Cartels, Incorporated: The Plan > A parody comic and a game. An invented company tries to grab every low-income smile in California, and you get to play the villain. The facts are in the boxes. - Canonical page: https://icantsmilecalifornia.org/dental-managed-cartels.html - Site: [I Can't Smile, California](https://icantsmilecalifornia.org/), described for agents in [llms.txt](https://icantsmilecalifornia.org/llms.txt) - Published 2026-10-08, last updated 2026-10-08 - Notice: Independent watchdog, commentary and satire project on Medi-Cal dental managed care. Not the State of California, the Department of Health Care Services, Medi-Cal Dental or the Smile, California campaign, and not connected to any of them. Not a dental plan. Not legal, medical or dental advice. This markdown copy is generated from the page for software agents; the page itself is the version of record. Issue No. 1 A parody in nine chapters Free, you already paid for it Many years ago, a few lawmakers tried to hand every low-income smile in California to one company. The plan never quite worked. The company never stopped trying. This is its story, told the only way it deserves: as a comic book. With a game at the front, where you get to be the villain. [Play the villain](https://icantsmilecalifornia.org/dental-managed-cartels.html#game) [Read the story](https://icantsmilecalifornia.org/dental-managed-cartels.html#contents) **Parody.** The company is invented. So are its bosses, its vault and its plan. The real record is in the boxes marked *Meanwhile*. Insert coin. It's taxpayer money. ## Dental Managed Cartels, LLC You are the new Architect of the Denial Machine. Swipe a card or tap a choice. Keep the vault full, the regulators asleep and the members quiet. See how long your reign lasts. ## In this issue 1. [1 The Back Room](https://icantsmilecalifornia.org/dental-managed-cartels.html#back-room) 2. [2 The Plan Falls Short](https://icantsmilecalifornia.org/dental-managed-cartels.html#falls-short) 3. [3 The Grip](https://icantsmilecalifornia.org/dental-managed-cartels.html#the-grip) 4. [4 The Capitation Extraction Model](https://icantsmilecalifornia.org/dental-managed-cartels.html#extraction) 5. [5 The Vanishing Referral](https://icantsmilecalifornia.org/dental-managed-cartels.html#vanishing-referral) 6. [6 The Inquiry Laundromat](https://icantsmilecalifornia.org/dental-managed-cartels.html#laundromat) 7. [7 The Mills](https://icantsmilecalifornia.org/dental-managed-cartels.html#the-mills) 8. [8 The Sleeping Regulators](https://icantsmilecalifornia.org/dental-managed-cartels.html#sleeping-regulators) 9. [9 Until the World Ends](https://icantsmilecalifornia.org/dental-managed-cartels.html#world-ends) Chapter 1 ## The Back Room Sacramento, many years ago. A room with no windows, one swinging lamp, and a table piled with money that didn't belong to anybody yet. Dental Managed Cartels, Incorporated had a pitch for a few lawmakers. Some of them were crooked. Some of them were just tired. All of them loved the words *cost savings*. The pitch was simple. Give us every low-income Californian. Pay us a flat fee for each one, every month. We'll handle the teeth. Sacramento. Many years ago. The Cartel: Every county. Every smile. One easy monthly payment. A lawmaker: Save money *and* fix teeth? Where do I sign? The Cartel: Right here. Don't read the part about the teeth. The Plan Top secret. Do not show the teeth. 1. Put every low-income Californian in our network. 2. Get paid per head, per month, no matter what. 3. Make care hard to reach. Hard is cheap. 4. Keep the regulators comfortable. 5. Repeat until the end of the world. Meanwhile, in the real record The back room is invented. The law was not. A 1994 state law told the Department to “place all Medi-Cal beneficiaries in dental managed care by October 1, 1995.” The stated goal: “to achieve major cost savings, while ensuring access and quality of care.” [The real history, with sources](https://icantsmilecalifornia.org/dental-managed-care.html#timeline) Chapter 2 ## The Plan Falls Short The Plan was supposed to cover the whole state. It didn't. County after county wriggled out of the net. But the Cartel got its hooks into one county and never let go. Every few years there's a new pitch, a new back room, a new reason to leave the net right where it is. Once, the State itself tried to cut it loose. Somehow, the net is still there. Meanwhile, in the real record Dental managed care runs in two of California's 58 counties. In Los Angeles it is optional. In Sacramento it is mandatory. In 2020 the State's own health department proposed ending it in both, writing that fee-for-service “continues to maintain higher utilization than DMC for both children and adults.” It did not happen. The contracts were extended instead. [The State's own verdict, with sources](https://icantsmilecalifornia.org/dental-managed-care.html#verdict) Chapter 3 ## The Grip Half a million people, in one county, held in one tight fist. In the Cartel's dream, nobody gets out. No other dentist. No other door. Nobody else to call. Just the network, the hold music and the monthly check. The law does leave one gap in the fist, written just for this county. The Cartel's favorite part? Almost nobody fits through it. When a member asks for the way out, the Cartel promises to call her back. It dials once, at 3 a.m., from a blocked number. Then it tells the State she didn't answer. Meanwhile, in the real record By the State's count, 551,922 people in Sacramento County were in Medi-Cal dental plans in August 2026, and joining one is not a choice there. There is a door. If you cannot get an appointment, a Beneficiary Dental Exception is supposed to move you to fee-for-service, where you choose your own dentist. How often has it opened? The State's own monthly reports for the first twelve months of the current contracts, July 2025 through June 2026, show 107 requests and 130 closed cases. Exceptions granted: **zero**. Fifty people were recorded as getting an appointment instead, and eighty as not responding. Later reports will show whether anyone gets out. **Tip:** if you ask for an exception, answer the phone, even numbers you don't know, and write down every call you get or miss, with the date and time. [The State's reports, month by month](https://icantsmilecalifornia.org/beneficiary-dental-exception.html#numbers) [How the exception works](https://icantsmilecalifornia.org/beneficiary-dental-exception.html) Chapter 4 ## The Capitation Extraction Model Now for the money. The Cartel gets a flat fee for every member, every month. Fix their teeth or don't, the check still comes. So every skipped cleaning is profit. Every lost referral is profit. Every gum left bleeding is profit. The Cartel has a name for this. It calls it the **Capitation Extraction Model**. Try it yourself. The machine is very easy to use. That's the problem. Meanwhile, in the real record The real contract does pay per member, per month, “regardless of whether a Member receives services.” There is a floor: a plan must spend at least 85 percent of the money on care or pay back the difference. That share is called the medical loss ratio. The State's actuaries wrote that “reported MLRs have fallen below 85% in recent years for some of the DMC plans.” [How the money works, with sources](https://icantsmilecalifornia.org/employment-penalty-of-a-broken-smile.html#money) Chapter 5 ## The Vanishing Referral A dentist looks in your mouth. Bleeding gums. Deep pockets. Bone slipping away. She writes a referral to a periodontist, the gum specialist. In the Cartel's world, that piece of paper has a strange habit of disappearing. No referral on file means no specialist to pay, and nothing to count. And the specialists? Hard to find. Some live only in the directory. Some were never there at all. Meanwhile, in the real record On 14 September 2026 the three Sacramento plan directories listed two periodontists for 551,922 members, and zero verified prosthodontists, the specialists who replace teeth. Once a specialist referral is approved, the contract gives the plan 30 business days to get an adult an appointment. **Tip:** ask your dentist for a copy of any referral they write, and keep it. [The specialist count, with sources](https://icantsmilecalifornia.org/dental-awards.html#category) [Getting your own records](https://icantsmilecalifornia.org/your-dental-records.html) Chapter 6 ## The Inquiry Laundromat When a member calls to complain, the Cartel has a trick. A grievance has to be answered, counted and reported to the government. An inquiry is just a question. So in the Cartel's call center, grievances go in the wash and come out as inquiries. Small, gray and easy to forget. The call notes that mention a referral get deleted. The recordings get overwritten. If it isn't written down, the Cartel says, it never happened. Meanwhile, in the real record California's rule says a grievance is any written or oral expression of dissatisfaction, and “where the plan is unable to distinguish between a grievance and an inquiry, it shall be considered a grievance.” Every grievance goes in a log the State reviews. **Tip:** write down the date, the time and the name of everyone you talk to. [The grievance rule, with sources](https://icantsmilecalifornia.org/your-dental-records.html#stall) [If your plan says no](https://icantsmilecalifornia.org/utilization-management.html#denied) Chapter 7 ## The Mills The Cartel doesn't work alone. It has partners: high-volume clinics that people in the business call Medicaid mills. Some are chains with a corporate office. Some wear the badge of a community clinic. They know the game. Fill every chair. Keep every visit short. Bill what pays, skip what doesn't, and never, ever refer out. Not every clinic plays. Plenty of dentists in these networks fight for their patients every day. This chapter is about the ones who don't. Meanwhile, in the real record Chain clinics and community health centers are paid in very different ways, and fraud can happen in each. We wrote up how it works, how it gets caught, and what California's own record shows. [DSO vs. FQHC: How Dental Fraud Can Happen in Each](https://icantsmilecalifornia.org/dso-vs-fqhc.html) Chapter 8 ## The Sleeping Regulators Every quarter the Cartel sends a report to the people who are supposed to watch it. The Cartel writes the report. The Cartel picks the numbers. The watchers read it, nod, and go back to sleep. In the Cartel's world, the Department of Eventually has been napping since the first back room. Only one thing wakes a regulator for good: a complaint with dates, names and copies attached. Meanwhile, in the real record Two real State departments watch Medi-Cal dental plans. The Department of Health Care Services holds the contract. The Department of Managed Health Care licenses the plan and takes complaints. Complain to your plan first. If it isn't fixed in 30 days, or right away if it's urgent, you can take it to the Department of Managed Health Care. [If your plan says no, step by step](https://icantsmilecalifornia.org/utilization-management.html#denied) Chapter 9 ## Until the World Ends The last step of the Plan was always the same. Repeat until the end of the world. The sun gets bigger. The oceans boil. The vault keeps filling. Somewhere, a member is still on hold. Unless. Unless the members keep copies. Unless the dentists put it in writing. Unless somebody, somewhere, wakes up the people who are paid to be awake. Four billion years later. The Cartel: Did this month's check clear? Or, maybe, sooner. Everyone: We kept copies. The small print, in large print ## This is parody **Dental Managed Cartels, Incorporated**, Dental Managed Cartels, LLC, the Board, Senator Ruby Stamp, the Department of Eventually, MegaMolar Mills and every other company and character in this comic and its game are invented. So are the back room, the vault, the Plan and the Cartel's methods. Nothing here is directed at any real person on planet Earth specifically. It is directed at any and all people who operate like this, in any way. Nothing in the story or the game is a finding that any real plan, company, clinic, lawmaker or regulator did any of it. The facts on this page are only in the boxes marked *Meanwhile, in the real record*, and each one links to the page of this site that shows its sources. Not sponsored by the State of California, DHCS, Medi-Cal Dental or any managed care plan. Not legal, medical or dental advice. If you think we have crossed a line, [our corrections policy](https://icantsmilecalifornia.org/about.html#corrections) applies to the Cartel too. [The Cartel's spokesman: Meet Bartle McShill](https://icantsmilecalifornia.org/bartle-mcshill.html) Vice President of Reassurance. He says he works for billionaires and would like you to know he is the good guy. Two minutes with slides. (parody) [From the claims department: Charity Boy](https://icantsmilecalifornia.org/charity-boy.html) Caroline denies claims for a living and sings about it over potato skins. Frederick does not take it well. A cartoon in one act. (parody) [The Cartel tried to stop this: We Can't Smile, California](https://icantsmilecalifornia.org/assets/audio/we-cant-smile-california.mp3) A cartoon band plays the Capitol lawn while Bartle sneaks behind the speakers with giant scissors. A minute and a half. (parody) ## Seen the Cartel at work? A referral that vanished, a grievance that turned into a question, a call nobody logged. If something like that happened to you, tell us what happened and when. No names needed. [Tell us what happened](https://icantsmilecalifornia.org/contact.html)