Medi-Cal Dental Coverage Change

What You Need to Know

These coverage changes will affect all Medi-Cal members who do not qualify for Full Scope Medi-Cal under federal immigration rules. If you received a letter from HPSM between April and June about dental coverage changes, the timeline has changed.

To check if you have satisfactory immigration status and qualify for Full Scope Medi-Cal, review the Immigration Status and Changes to Medi-Cal Eligibility chart from the California Department of Health Care Services.

If you fit into any of the categories listed on the chart, you have “unsatisfactory immigration status” and are not eligible for Full Scope Medi-Cal under the federal immigration rules. This means you will switch to Medi-Cal Dental Fee-for-Service beginning January 1, 2027.

Important Dates

• Today through December 31, 2026, full dental coverage will be available through HPSM Dental
• January 1 through June 30, 2027, Medi-Cal members who do not qualify for Full Scope Medi-Cal under federal immigration rules will have full dental coverage through Medi-Cal Dental Fee-for-Service until June 30, 2027.
• Starting July 1, 2027, Medi-Cal members who do not qualify for Full Scope Medi-Cal under federal immigration rules will have emergency coverage only through Medi-Cal Dental Fee-for-Service.

Do you qualify for an exception?

If you have “unsatisfactory immigration status” as defined by federal immigration rules, your dental coverage changes will depend on your age and circumstances.

Choose the option that best fits you to learn about the changes that may apply to you.

What should you do now?

• Schedule any dental care you need before December 31, 2026, especially if you are in the care of an HPSM Dental Provider. Call 650-616-1522 if you need assistance.
• Make sure you have your Medi-Cal Benefits Identification Card (BIC). If you can’t find your BIC, contact San Mateo County Human Services Agency.
• Make sure you stay informed about all Medi-Cal changes so you may be able to keep your coverage.  Learn more.
• Find out if your dentist is a Medi-Cal Dental Fee-for-Service provider. If you need help finding a provider, call HPSM Dental at 650-616-1522 or email dental@hpsm.org.
• Report any new pregnancy or the end of a pregnancy, contact San Mateo County Human Services Agency.
• Take the important steps to keeping your Medi-Cal coverage:
  • Keep your contact information and immigration status up to date. Visit www.benefitscal.org or San Mateo County Human Services Agency.
  • Make sure to open all your mail
  • Complete and submit all forms on time.
• Watch out for any future notices from Health Plan of San Mateo, San Mateo County or Department of Health Care Services about your medical and dental coverage.

If you have “unsatisfactory immigration status”, what do you need to know about your dental benefits?

• You can use your HPSM Dental benefits until December 31, 2026. Be sure to schedule any needed dental care before that date. Contact HPSM Dental at 650-616-1522 or email dental@hpsm.org.
• You should not pay any out-of-pocket costs for services without verifying with HPSM Dental (before December 31, 2026) and Medi-Cal Dental Fee-for-Service (after January 1, 2027).
• Starting January 1, 2027, if you have “unsatisfactory immigration status” your dental coverage will move from HPSM Dental to Medi-Cal Dental Fee-for-Service until June 30, 2027. You will have full dental coverage during this time.
• Starting July 1, 2027:
  • You will keep full Medi-Cal Dental benefits through the Medi-Cal Dental Fee-for-Service program if you are:
    • Younger than 19 years of age.
    • Pregnant or one-year postpartum (after pregnancy), and/or
    • A foster child/youth or former foster youth under age 26 who was in foster care on your 18th birthday.
  • Members who do not qualify for an exception based on their age, pregnancy, or foster care, will have dental coverage only for emergencies.
  • If you have a dental emergency, you can go to a Medi-Cal Dental provider for care.
  • To find a Medi-Cal dentist near you, go to the Medi-Cal Provider Directory webpage. Or call Medi-Cal Dental at 1-800-322-6384.
  • To learn more about Medi-Cal Dental, go to the Smile California webpage.

What is Medi-Cal Dental Fee-for-Service?

Medi-Cal Dental Fee-For-Service (FFS) is the main delivery system providing free or low-cost dental care in most California counties, allowing patients to visit any dentist who accepts Medi-Cal.

What are emergency dental services?

Emergency dental services are treatments needed right away to stop severe pain or diagnose and treat sudden, serious medical problems. Emergency dental services can be for:

• Bleeding that does not stop.
• Painful swelling in or around your mouth.
• A toothache or jaw pain.
• Injuries to your face or jawbone.
• A broken or knocked-out tooth.
• Infection in your gums or teeth with pain or swelling.       
• After surgery care (such as bandage changes or stitch removal).
• Cutting or fixing wires in braces that hurt your cheeks or gums.

To learn more about emergency services, go to the Smile California website.

San Mateo County Resources

• For questions about Medi-Cal eligibility, to report a pregnancy or change in immigration status, contact San Mateo County Human Services Agency.
  
  The San Mateo County local Medi-Cal office can be reached at:
  San Mateo County Human Services Agency
  400 Harbor Blvd., #B
  Belmont, CA 94002
  1-800-223-8383
  Office hours are 8:00 a.m. to 5:00 p.m.
  Or, to find local county Medi-Cal offices in other counties, go to the DHCS website.
• For questions about your current HPSM Dental plan, Contact HPSM Dental at 650-616-1522 or email dental@hpsm.org. There is no cost for this call.

California State Resources

• For questions about eligibility, benefits, and services, call the Medi-Cal Help Line Monday – Friday, 8:00 a.m. to 5:00 p.m. (except State holidays) at 1-800-541-5555. There is no cost for this call.
• Learn more about Medi-Cal Dental Fee-for-Service. Call Medi-Cal Dental Monday – Friday, 8:00 a.m. to 5:00 p.m. (except State holidays) at 1-800-322-6384. The re is no-cost for this call.
• To learn more about the upcoming Medi-Cal changes, read DHCS Frequently Asked Questions
• For help using your benefits and understanding your rights, email MMCDOmbudsmanOffice@dhcs.ca.gov. Or call 1-888-452-8609 (TTY: 711 for California State Relay), Monday – Friday, 8:00 a.m. to 5:00 p.m., except State holidays. There is no cost for this all. Or, visit the DHCS website.
• For help choosing health and dental plans, call Medi-Cal Health Care Options (HCO) Monday – Friday, 8:00 a.m. to 6:00 p.m. at 1-800-430-4263 (TTY: 1-800-430-7077). The call is free. Or go to Medi-Cal HCO at the DHCS website.
• To learn more about Medi-Cal program changes, go to the DHCS website.
• For questions about changes to the scope of Medi-Cal coverage based on immigration status, email ImmigrationPolicy@dhcs.ca.gov.

HPSM is here to help

We understand that this news can cause worry. Please remember that HPSM can support you. If you have questions about:

• Medi-Cal changes, visit or call San Mateo County Human Services Agency.
• Your current dental benefits, call HPSM Dental at 650-616-1522 (TTY: 1-800-735-2929or dial 7-1-1). Call center hours are Monday through Friday from 8:00 a.m. to 5:00 p.m.
• Your current medical benefits: