Dental Case Management Program
Dental Case Management is a program designed for Medi-Cal members with special health care needs who are unable to schedule and coordinate complex treatment plans involving one or more medical and dental providers. Case Management services are intended for members with significant medical, physical, and/or behavioral diagnosis or diagnoses. Examples of qualifying special healthcare needs include physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or other limiting condition that requires medical management, hospital dentistry, health care intervention, and/or use of specialized services or programs
Referrals for case management services are initiated by the member’s medical provider, dental provider, case worker or healthcare care professional and are based on a current, comprehensive evaluation and treatment plan.
To refer a Medi-Cal member, the member’s medical provider, dental provider, case worker or healthcare care professional must complete the online Case Management Referral Form. If you have questions when submitting the referral, please contact the Telephone Service Center (TSC) at (800) 423-0507.
All referrals are evaluated to determine eligibility based on case management criteria. Referrals that do not meet case management criteria will be routed to the TSC for care coordination assistance.
Care coordination services allow Medi-Cal members to call and gain access to extended dental services with the direction and support of our TSC representatives, who assist members with locating a general or specialist dentist, accessing appointments, translation services, and transportation assistance.
Members can access care coordination services by contacting the TSC at (800) 322-6384.