Shelf one: Articles
Longer reads on dental care, managed care and the life in between. Researched from primary sources, linked, and written to be read in one sitting.
Start readingLibrary
Five shelves. The articles we write about dental care, managed care and the life that happens in between. The fines California's regulator has issued against the plans, with every document linked. The rules, reports and files that everything else on this site rests on. A reading list on the much bigger blanket this slice sits under: Medicaid and Medicare, the fraud units, and California versus Washington. And an archive of other people's reporting that went off the internet. You can check all of it.
Shelf two: The enforcement ledger
Every fine the regulator has issued against the two dental-only plans, what each was for, what we know about Health Net's much larger file, and the settlements and sanctions its parent company has paid elsewhere.
Read the ledgerShelf three: The documents
The regulator's letters, the contract template, the plan letters and the State's own reports, in one place, so you never have to take our word for a characterization.
Open the shelfShelf four: The wider view
Medi-Cal dental managed care is one slice of a much bigger blanket. A reading list on Medicaid and Medicare, the fraud units, California's own watchdogs, and the argument between Sacramento and Washington over who pays.
Browse the listShelf five: The rescued archive
Nine years of reporting on Borrego Health by the Borrego Sun, all 83 stories of it, which the paper's own website stopped serving when it was rebuilt. Readable copies, with every original address and archive snapshot.
Open the archiveShelf one
Articles
Dental care, managed care, and the life that happens in between. Each piece is researched from primary sources and linked, like everything else here, with the opinion kept in its own box so you can always tell which one you are reading.
DSO vs. FQHC: How Dental Fraud Can Happen in Each
Medi-Cal pays a dental chain for every procedure and a community health center for every visit. Each rule rewards a different shortcut. How the two models work, how fraud can happen inside each, and the cases prosecutors and courts have actually proven, every one labeled by how far it got.
Read the articleThe Employment Penalty of a Broken Smile
Missing teeth cost people jobs. The research says so, the State knows it, and Medi-Cal pays three plans a flat monthly fee for every member to fix it. What happens between that payment and the dentist's chair is the story, with the numbers drawn out so you can see them.
Read the articleTwo articles so far, and more on the way. The idea of this shelf is simple: take one question people actually ask about their teeth, their plan or their life, research it properly, and write it up in plain words with every source linked.
If there is a question you want researched, tell us. If you have been through something an article describes, tell us that too.
Shelf two
The enforcement ledger
California fines these plans when they break the rules. Two of the three, Liberty and California Dental Network (DentaQuest), do dentistry and nothing else, so every fine against them is a dental fine and both ledgers are below in full. The third is Health Net, a large health plan whose file is mostly about medical care, so it gets its own section further down and no total. The documents are linked.
12
Fines on record, the two dental only plans
24
Years those fines span
$293k
What they add up to
$1,000
Price of not reporting your unresolved grievances
The ledger
California Dental Network, trading as DentaQuest
Five enforcement actions since 2006, totaling 266,000 dollars. This is the plan that also administers Health Net's dental benefits.
| Date | Penalty | What the regulator cited | Document |
|---|---|---|---|
| 26 Aug 2026 | $150,000 | Failure to adequately consider an enrollee's grievance. Failure to establish and maintain a department approved enrollee grievance system. Improper cancellation notices. | 23-768 |
| 5 Sep 2025 | $95,000 | Failure to reasonably and efficiently furnish subscribers with contracted health services. Claims paid late or wrongly denied. Failure to maintain books and records. | 24-291 |
| 18 Sep 2025 | $1,000 | Failure to file the quarterly report listing grievances over 30 days old that are still unresolved. | 25-323 |
| 25 Mar 2019 | $15,000 | Marketed and sold a dental product without an order of approval from the regulator, carried on selling it in breach of the Director's order of postponement, and advertised an unapproved product. | 18-818 |
| 26 Jan 2006 | $5,000 | Failure to submit the 2003 and 2004 antifraud annual reports. | 05-246 |
Read these with the dates in mind. California Dental Network (DentaQuest) only began covering Medi-Cal members on 1 July 2025. Not one of the five documents above mentions Medi-Cal or Medicaid, even once. They concern the company's other California dental business, the one where the member pays a monthly premium, and the conduct behind the two largest happened before the Medi-Cal contract existed. The 150,000 dollar action is about an enrollee who paid premiums between July and October 2023. The 95,000 dollar action comes out of an examination of the quarter ending 31 March 2023.
We publish them because they are the record of the company the state handed a Medi-Cal contract to. They are not Medi-Cal failures, and we are not going to dress them up as any.
One thing the public list does not show. The 1,000 dollar document records that the regulator had already dealt with this same failure twice before, in matters 24-388 and 24-756, and wrote to the plan on 5 November 2024 spelling out the deadline. The plan filed late again for the very next quarter. Neither of those two earlier matters appears anywhere in the public enforcement listing, so the ledger you can look up is shorter than the record the regulator holds.
Complete listing: DMHC enforcement actions for California Dental Network, Inc. (DentaQuest)
The ledger
Liberty Dental Plan of California
Seven enforcement actions since 2002, totaling 27,000 dollars. Four of them were settled on the same day in February 2025.
| Date | Penalty | What the regulator cited | Document |
|---|---|---|---|
| 24 Feb 2025 | $6,000 | Grievance and appeals reporting. | 24-423 |
| 24 Feb 2025 | $2,000 | Grievance and appeals reporting. | 24-422 |
| 24 Feb 2025 | $2,000 | Grievance and appeals reporting. | 24-424 |
| 24 Feb 2025 | $2,000 | Failure to file the quarterly report listing grievances over 30 days old that are still unresolved. | 24-755 |
| 29 May 2015 | $10,000 | Earlier action. See the document for the violations cited. | 14-334 |
| 29 Aug 2005 | $2,500 | Earlier action. See the document for the violations cited. | 05-257 |
| 13 Aug 2002 | $2,500 | Earlier action. See the document for the violations cited. | 02-019 |
Complete listing: DMHC enforcement actions for Liberty Dental Plan of California, Inc.
Read the codes, not the headlines
The same rule, broken again
Every action cites the regulation breached. Line the codes up and two of them keep coming back, both about grievances.
Rule 1300.68(f)(3)
Not reporting the grievances that are stuck
Plans must file a quarterly report listing grievances more than 30 days old that are still unresolved. It is the report that tells the regulator who is waiting.
Liberty was fined 2,000 dollars for missing it in February 2025. DentaQuest's plan was fined 1,000 dollars for missing it seven months later.
Rule 1368(a)(1)
Not having an approved grievance system at all
Plans must establish and maintain a grievance system the Department has approved. This is the floor, not a refinement.
Cited against California Dental Network (DentaQuest) in August 2026, alongside a finding that it failed to adequately consider an enrollee's grievance. Also cited against Health Net of California.
Why this matters here
Grievances are the only lever a Sacramento member has. They cannot change program, and until 2030 they cannot leave managed care. The complaint is the remedy. These are the rules about handling complaints, and they are the rules that keep getting broken.
For scale
What a fine is worth to a company this size
We are not going to tell you what to conclude. We are going to put two numbers next to each other.
$27,000
Every penalty California has imposed on Liberty Dental Plan of California since 2002, added together. Twenty-four years of enforcement.
$174.6 billion
Centene's premium and service revenues for 2025, as reported to its shareholders. Centene owns Health Net.
Those two figures describe different companies, and we are not pretending otherwise. The point is the order of magnitude that dental enforcement operates at. A thousand dollars for failing to tell the regulator which members are still waiting is not a number that changes how a company behaves. It is the price of a form.
The bigger files
The Health Net entities
Health Net is not only a dental plan, and this is where we have to be careful with you.
California's regulator lists 338 documents against Health Net of California, Inc. and 53 against Health Net Community Solutions, Inc. Those are large full-service health plans. The overwhelming majority of those actions concern medical care, not dentistry, and it would be dishonest to wave the number around as though it were a dental figure.
What is worth noting from the current page of each file is the kind of thing cited. Against Health Net Community Solutions: failure to ensure its contracted provider network has adequate capacity and availability of providers, and failure to decide on requests involving imminent or serious threats to a patient's health in time. Against Health Net of California: failure to establish and maintain a department approved enrollee grievance system, the same rule cited against DentaQuest's plan.
The newest entries in both files are the largest. On 4 February 2026 the regulator announced $1.3 million in fines against the two Health Net plans for mishandling payment disputes from dentists, doctors and hospitals: $850,000 against Health Net Community Solutions, which “failed to timely acknowledge 6,587 provider disputes within the required timeframes, and 36,848 provider disputes were not resolved in a timely manner,” and $450,000 against Health Net of California, which “failed to timely acknowledge 19,048 provider disputes and 15,368 provider disputes were not resolved within the required timeframes.” The larger of the two documents is on the shelf below. Neither is a dental action, and neither is added to the total above.
What we have not done
- Read all 338 Health Net of California documents, or all 53 for Health Net Community Solutions. We looked at the most recent page of each.
- Separated the dental actions from the medical ones in those two files. Until that is done, no total for Health Net appears on this page.
- Read the full text of the older dental actions from 2002, 2005, 2006, 2015 and 2019. The dates and amounts are from the regulator's index; the documents are linked if you want to go first.
Listings: Health Net of California, Inc. and Health Net Community Solutions, Inc.
Beyond the fines
Settlements and sanctions against Health Net and its parent
The dental fines above are small. The money that has actually moved against Health Net's owner, Centene, and against Health Net's Medi-Cal medical plan, is not. None of these actions is about Medi-Cal dental care, so none is added to the total above. They are listed for two reasons. Health Net has run a Medi-Cal dental plan in both counties for years, most recently through Health Net of California, Inc.; the new contract that took effect on 1 July 2025 was awarded to Health Net Community Solutions, Inc., the entity named in the first two rows, with DentaQuest doing the day to day work. And the first case below is about the same thing this site documents for dental: a directory that is full on paper.
| Date | Against | What happened, who acted, and the documents | Amount |
|---|---|---|---|
| 4 Feb 2026 | Health Net Community Solutions, Inc. and Health Net of California, Inc. | Department of Managed Health Care. Mishandled payment disputes from providers, 2017 to 2022. One plan left 6,587 disputes unacknowledged and 36,848 unresolved on time; the other 19,048 and 15,368. Press release, letter of agreement. | $1.3 million: $850,000 and $450,000 |
| 24 Nov 2025 | Health Net Community Solutions, Inc., Medi-Cal medical plan | Department of Health Care Services. Quality sanction for scoring below the State's minimum on care measures in five counties, Sacramento among them, in 2024. The fourth year running: $437,000 for 2021, $655,000 for 2022 and $519,000 for 2023 came before it. Letters for 2024, 2023, 2022 and 2021. | $327,000, and $1,938,000 over the four years |
| 13 Oct 2025 | HealthNet, LLC; Health Net of California, Inc.; California Health and Wellness Plan; Health Net Community Solutions, Inc. | California Attorney General and San Diego City Attorney. Inaccurate provider directories. A 2021 lawsuit alleged “error rates exceeding 18 percent overall and more than 35 percent for psychiatrists.” Medical and mental health directories, not dental. Attorney General, City Attorney. | $40 million: a $12 million payment plus about $28.5 million over six years on fixing the directories |
| 18 Feb 2025 | Health Net Federal Services, LLC and Centene Corporation | United States Department of Justice. False Claims Act. The military health contractor “failed to meet certain cybersecurity controls and falsely certified compliance with them in annual reports to DHA,” 2015 to 2018. Allegations only, no determination of liability. Justice Department. | $11,253,400 |
| 8 Feb 2023 | Centene Corporation, for Health Net and California Health & Wellness | California Attorney General. Overcharged Medi-Cal for prescription drugs, January 2017 to December 2018. “Centene leveraged advantages in its pharmacy benefit manager (PBM) contracts to save its managed care plans $2.70 per prescription drug claim over the two-year period.” The settlement “recovers twice the value of Centene's inflated price reporting.” Allegations only. Attorney General. | $215,392,758 |
The directory case is the one to read. The San Diego City Attorney's release calls the practice by its name, “so-called ‘ghost networks,’” and says the cases against Kaiser and Molina are still going. The Attorney General's line: “Under state law, all health insurance companies that do business in California must provide accurate provider directories, and Health Net is no exception.” The settlement covers Health Net's medical and mental health directories. The dental directories the same company publishes for Sacramento are scored on Dental Awards, and the State's own December 2025 notice about them is in the article.
California was one state of many. In its 2021 annual report Centene told shareholders that “we recorded a legal settlement reserve of $1.25 billion (inclusive of the nine states with which we have reached no-fault agreements) related to services provided by Envolve, our pharmacy benefits manager subsidiary, essentially during 2017 and 2018.” California's share was the settlement above.
The other two plans. We searched for settlements or monetary sanctions naming Liberty Dental Plan of California or California Dental Network (DentaQuest) and found none posted by a California or federal agency. If you know of one, send it and it goes in this table.
Amounts are as stated in each document. The Department of Health Care Services letters are final or imposition notices for Medi-Cal managed care quality measures; the plan may request a hearing. The complete regulator listings for Health Net of California, Inc. and Health Net Community Solutions, Inc. hold the $450,000 document and the rest of both files. Centene's annual report is at the Securities and Exchange Commission.
Shelf three
Go and read them yourself
Every enforcement letter above in one place, then the rules, reports and files the rest of this site rests on. These are the originals, not our summaries of them.
DentaQuest, grievance system
The largest dental penalty on record here, including failure to maintain an approved grievance system.
Open documentDentaQuest, services and claims
Failure to reasonably and efficiently furnish subscribers with contracted health services, plus claims handling.
Open documentDentaQuest, unresolved grievances
The quarterly report naming members whose grievances had passed 30 days without resolution.
Open documentLiberty, matter 24-423
The largest of four Liberty matters settled on a single day in February 2025.
Open documentLiberty, unresolved grievances
The same quarterly grievance report rule DentaQuest's plan was fined for seven months later.
Open documentHealth Net Community Solutions, provider disputes
A letter of agreement settling 27 matters at once. Between January 2017 and December 2022 the plan “repeatedly failed to resolve provider disputes within 45 working days,” and failed to acknowledge them on time. Announced 4 February 2026. Not a dental-specific action.
Open documentThe documents this site runs on
Cited across the site and gathered here so you do not have to hunt for them. Every link goes to the State, the federal register, the regulator or the Internet Archive, never to us. Where a page on this site quotes one of these, the quote is on that page with the page number.
The rules
- DHCS, Dental Managed Care contract, 2025 template. The published boilerplate every plan signs. Each plan's signed copy is not public and can add to it.
- DHCS, Dental All Plan Letter 22-006. Grievances, appeals and the prior authorization deadlines.
- DHCS, Dental All Plan Letter 26-006. Your records by app, and the 2027 prior authorization rules. Explained on Plan Letters.
- DHCS, every Dental All Plan Letter, the index.
- DHCS, DMC Methodology Overview. The only document that lists the six dental specialties a network is measured on.
- Federal rules: 42 CFR 438.206 on access to care and 42 CFR 438.210 on coverage decisions.
- State law: Health and Safety Code 1367.01 on decisions, 1368 on grievances, 1367.27 on directories, and Welfare and Institutions Code 14089.09, the Beneficiary Dental Exception.
The State's reports
- DHCS, Beneficiary Dental Exception reports, monthly. Read on our BDE page.
- DHCS, network adequacy filings, including the 2025 report to the federal government. Read on Dental Awards.
- HSAG for DHCS, External Quality Review technical report 2023 to 2024, volume 2, and the 2021 to 2022 report.
- DHCS, Health Net dental audit reports for 2023 to 2024 and 2024 to 2025, from the dental managed care page.
- CHHS Open Data, Medi-Cal Managed Care Enrollment Report. Every plan, every county, every month since 2007.
- DHCS, Restoration of Dental Fee-For-Service in Sacramento and Los Angeles Counties, 2020, the year the State proposed ending dental managed care. Internet Archive copy.
- Barbara Aved Associates for Sacramento County, Sacramento Children and Dental Care: Better Served than 5 Years Ago?, December 2015. Internet Archive copy.
The plans and the regulator
- Medi-Cal Dental, Medi-Cal Dental Member Handbook, 2025.
- Medi-Cal Dental, Dental Managed Care member contact information. Each plan's member line by county.
- The three plans' provider directories, searched and scored on Dental Awards, and the reviewer names on Find a Director.
- DMHC enforcement listings for California Dental Network (DentaQuest), Liberty Dental Plan of California, Health Net of California and Health Net Community Solutions.
- DMHC, File a Complaint, and the online complaint form. Help Center 1-888-466-2219.
Shelf four
The wider view
Medi-Cal dental managed care is one slice of a much larger blanket. Above it sit Medicaid and Medicare, the federal and state units that chase fraud, waste and abuse in both, and a running argument between California and Washington over who pays for what and on what terms. This shelf is a reading list, not our reporting. Every link goes to the agency, the report or the law itself, with a line on what you will find there. Where an item is about Medi-Cal dental managed care, we say more.
Jump to Medicaid and Medicare, the fraud units, California's own watchdogs, California versus Washington or the dental slice.
Medicaid and Medicare, from the top
- MACPAC, the commission that advises Congress on Medicaid, Medicaid 101. A one page primer: what Medicaid is, who it covers, how Washington and the states split the bill, and why the rules differ from state to state, “effectively creating 56 different Medicaid programs.” Medi-Cal is California's.
- Office of the Federal Register, 42 CFR Part 438, Managed Care. The federal rulebook that every state's contract with a Medicaid managed care plan has to follow, dental plans included: access standards, enrollee rights, grievances and appeals, quality, and the program integrity safeguards. One very long page.
- Federal Register, Medicaid and CHIP Managed Care Access, Finance, and Quality, final rule of 10 May 2024. The rewrite that added appointment wait time standards, secret shopper surveys, provider payment analyses, remedy plans where access falls short, medical loss ratio rules and a quality rating system. In force from 9 July 2024, with later dates for many of its parts.
- Office of the Federal Register, 42 CFR 438.608, program integrity requirements under the contract. The section that sets the fraud, waste and abuse floor under every plan contract: a compliance program and a compliance officer who reports to the chief executive and the board, prompt reporting of overpayments and suspected fraud, and screening of providers.
- HHS Office of Inspector General, Managed Care. The inspector general's hub for its watch on Medicare Advantage and Medicaid managed care, with its audits, evaluations, settlements and open recommendations in one place. “The OIG has designated oversight of managed care as a priority area.”
- Government Accountability Office, Strengthening Medicaid Program Integrity, the Medicaid entry on the 2025 High Risk List. Medicaid has sat on the congressional watchdog's high risk list since 2003. The 2025 entry says the program “served approximately 73 million low-income and medically needy individuals at the cost of about $611 billion” in fiscal year 2024, puts improper payments at over $31 billion, and rates federal progress as partially met on all five of its tests.
- Government Accountability Office, Medicaid Managed Care: Improper Payment Estimate, 26 June 2025. Short questions and answers on why the official error rate for Medicaid managed care has sat at or near zero in recent years: the estimate stops at the State's payment to the plan and does not review what the plans pay providers. About three quarters of Medicaid members are in managed care.
- Medicaid.gov, Program Integrity. The federal Medicaid program integrity landing page: the Comprehensive Medicaid Integrity Plan, the annual report to Congress, the contractor audits of providers, and the support CMS says it gives states in their own efforts against provider fraud and abuse.
- Centers for Medicare and Medicaid Services, Center for Program Integrity. The CMS center that owns fraud, waste and abuse work across Medicare, Medicaid and CHIP. One of its listed priorities: “Expand the scope of our integrity programs related to Medicaid managed care enforcement and oversight.”
The fraud units
- U.S. Department of Justice, Health Care Fraud Section. The home of the federal prosecutors who bring the criminal cases against schemes that bill Medicare, Medicaid and TRICARE, the military health plan: “over 75 experienced white-collar prosecutors dedicated exclusively to prosecuting the nation's most complex health care fraud matters,” the strike force model explained, and the 2025 and 2026 national takedowns linked.
- U.S. Department of Justice, 2026 National Health Care Fraud Takedown, 23 June 2026. The newest coordinated sweep: 455 defendants charged over alleged schemes involving more than $6.5 billion in false claims, with 50 state Medicaid fraud units taking part. For the first time the release counts Medicaid on its own, 295 defendants and over $518 million. Charges, not convictions.
- U.S. Department of Justice, False Claims Act Settlements and Judgments Exceed $6.8B in Fiscal Year 2025, 16 January 2026. The yearly tally under the civil law used to claw money back from companies that overbill the government. The year to 30 September 2025 was the largest on record, with over $5.7 billion from health care, and the release names managed care as one of three major areas of health care enforcement.
- HHS Office of Inspector General, Report Fraud, Waste, and Abuse. The federal hotline for Medicare and Medicaid: what it handles, what it does not, what to gather first, and the online form.
- HHS Office of Inspector General, Exclusions Program. The List of Excluded Individuals/Entities, the federal register of people and companies barred from being paid by Medicare or Medicaid, searchable online. State Medicaid programs must check it every month and on every new enrollment.
- HHS Office of Inspector General, Medicaid Fraud Control Units. The 53 state units that investigate and prosecute Medicaid provider fraud and the abuse or neglect of patients, which the federal inspector general certifies and helps fund and which must be “separate and distinct from the State Medicaid agency.” California's is listed under the State's own watchdogs.
- HHS Office of Inspector General, Medicaid Fraud Control Units Annual Report: Fiscal Year 2025, 18 March 2026. The newest scorecard for those units: 1,185 convictions, recoveries of almost $2 billion, and “$4.64 for every dollar spent by States and the Federal Government.” It also counts the fraud referrals the units got from managed care plans, 5,991 in the year.
- HHS Office of Inspector General and the Department of Justice, Health Care Fraud and Abuse Control Program Report, Fiscal Year 2023, 6 December 2024. The joint annual report required since the 1996 HIPAA law created the program that pays for federal health care fraud enforcement, with what came back to the Medicare trust funds and to Medicaid. Still the newest one published as of September 2026.
- Medicare.gov, Reporting Medicare fraud and abuse. The consumer page for the other big program: how to spot it, protect a Medicare number and report it, with a separate line for Medicare Advantage and drug plans.
California's own watchdogs
- California Attorney General, Division of Medi-Cal Fraud and Elder Abuse. The State's Medicaid fraud unit: “The California Attorney General's Office, Division of Medi-Cal Fraud and Elder Abuse operates as the Medicaid Fraud Control Unit (MFCU).” It prosecutes people who defraud Medi-Cal and protects residents of care facilities from abuse or neglect. Its complaint form takes reports about any Medi-Cal provider, dentists included. Line (800) 722-0432.
- DHCS, Stop Medi-Cal Fraud. The State health department's own fraud hotline, (800) 822-6222, free and open to anonymous callers, with an online form, a mail address and short explainers on what counts as fraud and how complaints are handled.
- DHCS, Audits and Investigations. The division DHCS calls its Program Integrity Unit for Medi-Cal. One part audits the plans: it “conducts state mandated medical and compliance reviews and audits to verify compliance with contractual requirements for the Drug Medi-Cal Organized Delivery Systems and medical, dental and behavioral health managed care plans.” Another investigates provider and member fraud.
- DHCS, Managed Care Monitoring. The hub for how the State watches its Medi-Cal managed care health plans: audits, data, network adequacy, reports and sanctions. Its medical audits page lists each plan's most recent audit and the corrective action plan that followed. The dental plans' audit reports sit on the dental program page, further down this shelf.
- DHCS, Administrative and/or Financial Sanction Letters. The letters DHCS sends when it fines or sanctions a Medi-Cal managed care plan, posted by year. The State “may impose administrative and financial sanctions on Medi-Cal managed care health plans (MCPs) that violate applicable California Medi-Cal and federal Medicaid laws.” The quality sanctions against Health Net's medical plan are among them, and are in the settlements table on this page.
- California Legislative Information, Welfare and Institutions Code 14197.7. The State law that lets the DHCS director end a plan's contract or sanction it, with tools that include temporary management, a halt to new default enrollment and money penalties. One of the listed grounds: “The contractor fails to demonstrate that it has an adequate network to meet anticipated utilization in its service area.”
- DHCS, Suspended and Ineligible Provider List. California's own list of providers barred from Medi-Cal, updated monthly, alongside the federal exclusion list above. “Suspension is automatic when any of the above events occurs,” such as a fraud conviction or a lost license.
- California State Auditor, Improved Monitoring of Medi-Cal Managed Care Health Plans Is Necessary to Better Ensure Access to Care, 16 June 2015. Found that DHCS did not check the plans' network data before certifying their networks, approved directories with wrong phone numbers and addresses, and “has not performed all statutorily required annual medical audits” of the plans.
- California State Auditor, Although Its Oversight of Managed Care Health Plans Is Generally Sufficient, It Needs to Ensure That Their Administrative Expenses Are Reasonable and Necessary, 4 April 2019. The fraud finding: DHCS “does not consistently ensure that health plans have proper processes in place to prevent, identify, and address fraud.”
- California State Auditor, Children Enrolled in Medi-Cal Face Challenges in Accessing Behavioral Health Care, 28 November 2023. About mental health care, but its findings are about the same enforcement machinery that oversees every plan: “the department's enforcement activities do not always ensure that a plan takes steps to meaningfully improve access.”
- California State Auditor, State High-Risk Audit Program, updated assessment, 11 December 2025. DHCS stays on the State's high risk list over Medi-Cal eligibility, the problem behind the auditor's 2018 finding of $4 billion in questionable payments, and the auditor says it has recently started more in-depth audits of Medi-Cal eligibility determinations. DHCS's printed response says it “has a different view.”
- Department of Managed Health Care, Enforcement Actions Database. The other regulator, which licenses health plans under the Knox-Keene Act, dental plans included. “The Enforcement Action Database allows a user to search enforcement actions posted since July 1, 2000,” by plan, date, penalty or the law broken. Every fine in the ledger on this page came from it.
California versus Washington
- Congress.gov, H.R. 1 of the 119th Congress, which became Public Law 119-21 on 4 July 2025, with the enacted text at GovInfo. The 2025 federal budget law whose Medicaid sections drive most of what follows: work and reporting rules for certain adults, renewals every six months, limits on the taxes states use to draw federal money, and changes to which immigrants federal Medicaid money can cover. Congress.gov calls it the One Big Beautiful Bill Act, CMS calls it the Working Families Tax Cut, and California's budget documents call it H.R. 1.
- KFF, Health Provisions in the 2025 Federal Budget Reconciliation Law, 22 August 2025. A nonprofit's section by section summary of the law's health provisions, not a government document, each paired with the Congressional Budget Office's estimate. It relays the CBO's view that the law will “reduce federal spending on health care by over $1 trillion and lead to a 10 million increase in the country's uninsured population.” The easiest place to start.
- Federal Register, Medicaid Program; Community Engagement Requirement for Certain Individuals, interim final rule of 3 June 2026, effective 31 July 2026. The rule that tells states how to run the law's new work and community engagement condition for certain adult Medicaid members. “States are required to implement the new requirement no later than January 1, 2027.” California is suing over parts of it, below.
- DHCS, Implementation Plan for New Federal Eligibility and Enrollment Changes Under H.R. 1, with the plan itself, dated 29 January 2026. California's own schedule for carrying out the federal changes, provision by provision, with the federal effective dates: new eligibility rules from 1 October 2026; work reporting, six month renewals, duplicate enrollment checks and shorter retroactive coverage from 1 January 2027; cost sharing for the expansion adult group from 1 October 2028. The plan says the changes “are expected to impact up to two million Medi-Cal members.”
- California Department of Finance, California State Budget 2026-27, Health and Human Services, the enacted budget summary. The State's price tag: the federal law brings “costs of approximately $1.3 billion General Fund in 2026-27,” with disenrollment projected at “44,000 in 2026-27 and 1.3 million by 2029-30.” A rewritten tax on health plans starts 1 January 2027 because the current one “expires on December 31, 2026.” And because federal policy now bars covering emergency care for people with unsatisfactory immigration status “in risk-based managed care delivery systems,” those members “will receive all covered Medi-Cal services through the fee-for-service delivery system, effective January 1, 2027.” Taken at its word, that includes dental care in Sacramento County.
- Legislative Analyst's Office, The 2026-27 Budget: Medi-Cal Analysis, 2 March 2026. The Legislature's own analysts on the Governor's Medi-Cal budget, with sections on the federal law and on oversight. Under the new federal rules “the state will need to notably reduce two large provider taxes,” the tax on health plans and the fee on private hospitals.
- California Attorney General, the lawsuit over sharing Medicaid data with immigration enforcement, 1 July 2025. A coalition of states sued in the Northern District of California after federal health officials gave the Department of Homeland Security access to Medicaid enrollee files. The court granted preliminary relief on 12 August 2025 that “blocks DHS from using Medicaid data obtained from plaintiff states for immigration enforcement purposes,” and on 27 March 2026 the State asked the court to enforce its third order in the case. DHCS's own statement on the case says that on 29 December 2025 a federal court ruled that CMS “may share limited information with Immigration and Customs Enforcement (ICE) only for individuals who are not” lawfully residing in the United States.
- California Attorney General, the lawsuit over the work requirement rule, 29 June 2026. California co-leads 24 attorneys general and two governors challenging parts of the 3 June 2026 rule above, arguing that its reading of terms such as “medically frail” makes it harder for people with serious illnesses and disabilities to be excused. Filed in the District of Massachusetts.
- Federal Register, Preserving Medicaid Funding for Vulnerable Populations-Closing a Health Care-Related Tax Loophole, final rule of 2 February 2026, effective 3 April 2026. It “addresses a loophole in a regulatory statistical test applied to State proposals for Medicaid tax waivers,” the test that decides whether a state tax on health plans can count toward the federal match, and it names no state. California's tax is the kind it describes: the Legislative Analyst's analysis of Proposition 35, the 2024 ballot measure on that tax, puts it plainly: “The tax rate is higher for those in Medi-Cal compared to other kinds of health coverage.”
- Centers for Medicare and Medicaid Services, CMS Increasing Oversight on States Illegally Using Federal Medicaid Funding for Health Care for Illegal Immigrants, 27 May 2025. The federal announcement that it would review selected states' Medicaid spending reports and financial systems and recoup the federal share of anything spent on people whose immigration status makes them ineligible. It names no state. The State's answer sits in the 2026-27 budget summary above.
- MACPAC, Matching rates. How the federal government sets its share of each state's Medicaid bill, the Federal Medical Assistance Percentage, with a floor of 50 percent and a ceiling of 83 percent. The official table for October 2026 to September 2027 puts California at the floor, 50.00, so the State pays half of most Medi-Cal spending itself.
- DHCS, CalAIM 1115 Demonstration and 1915(b) Waiver. The two federal permissions Medi-Cal managed care runs on, dental managed care included, which CMS approved on 29 December 2021, “both effective through December 31, 2026.” The page holds California's 2026 renewal applications and the public comments on them. On 27 September 2026 it listed the applications but no federal approval of them yet. The 1915(b) renewal summary says the waiver that carries Dental Managed Care “is set to expire on December 31, 2026.”
The dental slice, up close
Where the blanket meets the part this site covers: the reports, letters and laws about Medi-Cal dental, and above all about the dental plans in Sacramento and Los Angeles counties. These get a longer note each.
The Legislature's analysts on ending dental managed care
The Governor's 2020-21 budget proposed ending dental managed care in both counties and moving everyone to fee-for-service. In The 2020-21 Budget: Analysis of the Medi-Cal Budget, the Legislative Analyst's Office counted six dental plans covering about 800,000 people, dental use around 15 percent lower than in fee-for-service, preventive care lower still, and spending per person around 50 percent higher. Its verdict: “dental managed care has not achieved its objectives of achieving savings while ensuring access and quality.”
It asked the Legislature to press DHCS for a detailed transition plan. The change never happened, and what came next is on our dental managed care page.
Read the analysisThe State's own report card for 2019
DHCS's report to the Legislature, 2019 Activities Relating to Medi-Cal Dental Managed Care. About 924,772 members across the two counties, 483,537 of them in Sacramento; the monthly rate paid per member, $11.67 for a child and $20.49 for an adult in Sacramento; and plan by plan results on 13 performance measures.
It also records that when DHCS checked the plans' networks in 2019 it found “providers were listed at locations where they were not practicing,” and put all three plans of the time on a corrective action plan. On 27 September 2026, DHCS's program page listed these yearly reports up to the one on 2020 activities, submitted in August 2021, and none after it.
Open the reportMedi-Cal Dental Managed Care, the State's own page
Where DHCS posts its oversight of the dental plans: every audit since 2020 with the corrective action plan that followed, the notices of deficiency and warning letters, the child satisfaction surveys and the reports to the Legislature. The newest audit is Liberty's, done on site in February 2026, with DHCS's response dated 10 September 2026. Health Net's audit, done in September 2025 and issued 12 February 2026, found that “The decision makers for the Plan's orthodontic appeals did not possess orthodontic experience.”
A federal transparency rule is answered in one line: “none of the Dental Managed Care plans have been accredited for their Medi-Cal lines of business with a private independent accrediting entity.” Health Net's latest audits are also on the documents shelf, and the September 2026 warning letters are explained in our article.
Open the pageThe data audit page, with one report on it
Despite its name, DHCS's Dental Managed Care Audit Reports page is not where the plan audits live. It exists for a federal rule, 42 CFR 438.602, under which the State must, “no less frequently than once every 3 years,” have an independent audit done of “the accuracy, truthfulness, and completeness of the encounter and financial data” each plan submits, and must post “the results of any audits” on its website.
On 27 September 2026 the page listed one report: the audit of the financial data Health Net's dental plan reported for calendar year 2022, done for DHCS by the consulting firm Mercer and dated 26 July 2024. It found “the results of the audit are determined to be immaterial and do not warrant corrective action.” The matching page for the medical plans lists two reports, both for 2022.
Open the pageThe dental plans' duty to report fraud
Dental All Plan Letter 22-005, Fraud, Waste, and Abuse Reporting, tells the dental plans how to pass suspected fraud to the State, under the federal rule at 42 CFR 438.608 above. “DMC Plans must report to DHCS all cases of suspected fraud, waste, and/or abuse when there is reason to believe that an incident of fraud, waste, and/or abuse has occurred by subcontractors, members, providers, or employees.”
A plan must finish a preliminary investigation and report its results within ten business days of first becoming aware of the activity, on the State's Confidential Medi-Cal Complaint Report, form MC 609, to the intake unit of DHCS's Audits and Investigations division. The final results of the investigation are due within ten business days of its close.
Read the letterAdult dental for some immigrants: now no sooner than July 2027
The 2025 budget set 1 July 2026 as the earliest date that adults on Medi-Cal with unsatisfactory immigration status would lose dental care other than emergencies, and DHCS told counties in a letter of 30 December 2025 to expect a “Full Scope with no Dental” coverage group. The 2026 budget law moved the date. Welfare and Institutions Code 14007.8 now reads: “No sooner than July 1, 2027, an individual who is 19 years of age or older, who is eligible for Medi-Cal benefits pursuant to subdivision (a), shall not be eligible for dental services set forth in this chapter,” except emergency care.
Foster youth and former foster youth keep full coverage until their 26th birthday, pregnancy and postpartum coverage is untouched, and nothing changes until the DHCS director confirms in writing that the systems are ready. Medi-Cal Dental's July 2026 bulletin told dentists the change “has been delayed until July 1, 2027.” Separately, the 2026-27 budget summary above moves Medi-Cal members with unsatisfactory immigration status to fee-for-service for all their care from 1 January 2027.
Read the lawChildren not getting the dental care Medicaid requires
Most Children With Medicaid in Four States Are Not Receiving Required Dental Services checked 2011 and 2012 claims for children in California, Indiana, Louisiana and Maryland, 2,091,343 of them in California. “We found that three out of four children did not receive all required dental services, with one in four children failing to see a dentist at all.”
Unlike the 2015 billing study further down, it counted the managed care plans too: “California provided managed care claims from Los Angeles County and Sacramento County.” It made eight recommendations to CMS.
Open the reportFixing Denti-Cal
Report 230 from the Little Hoover Commission, an independent state oversight agency, on the program then called Denti-Cal. It found that at least five counties had no Denti-Cal providers at all and made 11 recommendations, starting with a target of 66 percent of children on Denti-Cal seeing a dentist each year.
On the two managed care counties: “Both had relatively rough starts and poor track records in getting children into dentist offices for checkups.” It noted that “the California Dental Association has called on the state to end dental managed care in Sacramento County,” and that “the Commission is not making recommendations to encourage the expansion of managed care.” The Commission's site blocks automated readers, so we read the Internet Archive's copy of February 2026.
Read the reportDental, the wider rules
- HHS Office of Inspector General, Questionable Billing for Medicaid Pediatric Dental Services in California, May 2015. A study of 2012 fee-for-service claims, not the managed care plans. “We identified 329 general dentists and 6 orthodontists in California with questionable billing.” Medicaid paid them $117.5 million that year, and “half of the dental providers with questionable billing in California worked for dental chains.”
- California State Auditor, Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care, Report 2013-125, December 2014. “Federal data showed that nearly 56 percent of the 5.1 million children enrolled in Medi-Cal in federal fiscal year 2013 did not receive dental care through the program,” and California's rate “was the 12th worst among the states that submitted data.” Its recommendations were aimed at fee-for-service. The auditor tracks what DHCS did about each one.
- Medicaid.gov, Dental Care. The federal rules in brief. “States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but states choose whether to provide dental benefits for adults.” For children, “Dental services may not be limited to emergency services for children entitled to EPSDT,” the federal checkup and treatment benefit.
- Medicaid.gov, EPSDT Data. The yearly form CMS-416, on which every state reports, among other things, the “Number of children receiving dental services,” with state by state files going back to 1995.
- MACPAC, Medicaid Coverage of Adult Dental Services, January 2021. Adult dental is optional: “Three states provide no adult dental benefit, and nine states cover emergency services only.” And “California eliminated coverage of non-emergency dental services for adults in 2009,” restoring it in two steps, in 2014 and 2018.
- MACPAC, Oversight of and Accountability for Pediatric Oral Health Services in Medicaid Managed Care, September 2020. A slide deck on how states hold managed care plans to account for children's dental care. It lists California among the states that carve dental out to separate contractors, and ends on the question “Are existing oversight and accountability sufficient for ensuring further improvements?”
- Medi-Cal Dental, Provider Handbook, Section 8: Fraud, Abuse, and Quality of Care. How the fee-for-service program polices dentists: billing compared with peers, clinical screening examinations of patients, audits, recovery of payments and civil money penalties, with a mail address for reports and the promise that “Anonymity will be maintained upon request.”
Every link on this shelf was opened and read on 27 September 2026, and the descriptions come from the documents themselves. Congress.gov and the Little Hoover Commission block automated readers, so for those two we read the Internet Archive's copy. Government pages move. If one of these dies, tell us and we will fix it.
Shelf five
The rescued archive
Reporting other people did, which stopped being readable where it was published. We keep copies so it can still be read, each one carrying the address it used to live at and the archive snapshot it came from. This shelf starts with one run.
The Borrego Sun on Borrego Health
From December 2015 to May 2024 the Borrego Sun, a weekly in a desert town of about 3,000 people, covered the health center chain at the middle of one of the largest Medicaid fraud cases in the country. The FBI raided it, the State froze its payments, it filed for bankruptcy, and the dental side of it is why this archive sits on a California dental site.
In the spring of 2025 the paper replaced its website. The back catalog did not come across, and not only this section: stories from every part of the paper return a Not Found now. All 83 clinic stories are here, taken from Internet Archive snapshots.
Open the archive, all 83 storiesWhere it meets this site
Borrego Health's chief dental officer from 2017 to 2022 was Timothy S. Martinez, DMD. Since 1 March 2022 he has been the dental director of Health Net, one of the three Medi-Cal dental plans in Sacramento and Los Angeles counties. We have found no public record accusing him of any wrongdoing, and none charging him with anything.
The piece that led us to the Borrego Sun is still published by its author, Michael W. Davis, DDS, who wrote on the dental side of the case in May 2022. Many of its links point at Sun stories that no longer resolve. They resolve in the archive.
Read the dental director's recordEvery one of the 83 original addresses was checked on 7 October 2026 and all 83 returned a Not Found. These are other people's words, reproduced so they can still be read, each copy naming its writer, its paper and the issue it ran in. Anything asserted in them is the writer's own, and allegations in them were allegations when published. If you wrote one of them, or you are the paper, and you want something changed or taken down, tell us and we will act on it.
Still to come
A running log of public records requests: what was asked for, when, which agency, and where each one has got to. Plus the corrective action plans that sit behind the audit reports on the documents shelf, which tell a parallel story to the fines.
Filed a grievance that went nowhere?
The reports these plans were fined for not filing are the reports that count people like you. If you have been waiting more than 30 days, we would like to know.