HPSM Dental providers,
Last month, HPSM held a webinar outlining projected changes to Proposition 56 payments and dental benefit coverage, based upon the proposed California state budget and direction from HPSM’s state regulators.
This week, the state budget was finalized with two critical changes that postpone payment and eligibility reductions. These updates are different from the proposed changes we previously shared via webinar and provider notices. They positively impact our HPSM Dental providers in two ways:
- Elimination of Proposition 56 Dental Payments has been delayed one year. Proposition 56 Dental payments were previously slated to end on July 1, 2026. They have been extended 12 months, until July 1, 2027.
- Elimination of dental benefits for some members has been delayed one year – however many members WILL have different dental coverage starting Jan 1, 2027.
Previously, many HPSM members were slated to lose their dental coverage on July 1, 2026 due to eligibility changes related to immigration status. This benefit elimination has now been delayed, with the following changes:
- For the remainder of 2026, all HPSM Dental members will retain their dental coverage through HPSM. Continue to see your HPSM Dental members as usual through the end of the year.
- Beginning January 1, 2027 HPSM members with certain immigration statuses will no longer have dental coverage through HPSM. Their dental coverage will transition to California’s Medi-Cal Dental Fee-For-Service (FFS) program. Their California Medi-Cal Dental FFS coverage will last through July 1, 2027. To learn more about California’s Medi-Cal Dental FFS program please visit: https://dental.dhcs.ca.gov/
- Beginning July 1, 2027 some HPSM members (aged 19 and older, with certain immigration statuses, and who do not qualify for an exemption) will no longer be eligible for California Medi-Cal Dental FFS coverage, except for emergencies. See further detail below.
What this means for you:
- Please continue to see HPSM members as you have been.
- Please look for a Provider Bulletin from the Department of Health Care Services (DHCS). DHCS will be publishing a Provider Bulletin with additional detail, regarding the July 1, 2027 elimination of dental benefits for some members based on immigration status.
- If HPSM members have questions or need help understanding their eligibility or immigration status, refer them to San Mateo County Human Services Agency at 650-802-6470 Monday through Friday between 8AM to 5PM.
- If HPSM members have questions or need help understanding their rights, have them email MMCDOmbudsmanOffice@dhcs.ca.gov or call 1-888-452-8609.
- HPSM will be conducting additional member and provider outreach as we receive more information from DHCS and as we plan for the new implementation date of these changes. In the meantime, please direct questions to HPSM Dental at dental@hpsm.org.
Which HPSM members will lose dental coverage starting July 1, 2027?
Members with certain immigration statuses will lose their California Medi-Cal Dental FFS coverage starting July 1, 2027. Depending on when you receive this notice, please note that the effective dates in the webpage may not yet be updated to reflect the July 1, 2027 postponement. Details are listed here: https://www.dhcs.ca.gov/Medi-Cal/Pages/immigration-status-categories.aspx
Exceptions to the July 1, 2027 loss of California Medi-Cal Dental FFS coverages include:
- People younger than 19 years of age.
- People 19 years and older with certain immigration statuses will continue to be eligible for non-emergency dental services through California Medi-Cal Dental FFS if they are:
- Pregnant, and up to one year after pregnancy.
- Between 19-26 and were in foster care on their 18th birthday.
Questions about this notification? Please direct them to dental@hpsm.org.
Thank you,
The Health Plan of San Mateo