AB350 - Health care coverage: fluoride treatments.

Amended IN Senate August 20, 2026 Amended IN Senate May 13, 2026 Amended IN Senate September 05, 2025 Amended IN Senate July 07, 2025 Amended IN Assembly May 23, 2025 Amended IN Assembly April 24, 2025 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Assembly Bill No. 350 Introduced by Assembly Member Bonta (Coauthor: Assembly Member Jackson) (Coauthor: Senator Rubio) January 29, 2025 An act to add Section 1367.73 to the Health and Safety Code, to add Section 10120.45 to the Insurance Code, and to amend Section 14132 of the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 350, as amended, Bonta. Health care coverage: fluoride treatments. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies. Existing law requires an individual or small group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, to include, at a minimum, coverage for essential health benefits pursuant to the federal Patient Protection and Affordable Care Act. Existing law requires an essential health benefit to be provided only to the extent that federal law does not require the state to defray the costs of the benefit. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, that provides coverage for the application of fluoride varnish as a pediatric oral care benefit to provide coverage without cost sharing for the application of fluoride varnish as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit, except as specified. If this coverage requirement creates an obligation for the state to defray costs for an individual, the bill would not require coverage unless there is an appropriation for this purpose, as specified. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to low-income individuals. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program and provides for various services, including certain dental services, that are rendered by Medi-Cal enrolled providers. Under existing law, silver diamine fluoride treatments are a covered benefit for eligible children 0 to 6 years of age, inclusive, as specified, and application of fluoride or other appropriate fluoride treatment is covered for children 17 years of age and under. This bill would make the application of fluoride or other appropriate fluoride treatment, as defined by the department, a covered benefit under the Medi-Cal program for children under 21 years of age. The bill would require the State Department of Health Care Services, no later than July 1, 2027, to issue billing guidance and make any necessary updates to ensure the coverage policy for Medi-Cal beneficiaries under 21 years of age is consistent with certain federal benefits and would require that policy to allow the application of fluoride varnish, as specified. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. This bill would incorporate additional changes to Section 14132 of the Welfare and Institutions Code proposed by AB 1949 and SB 944 to be operative only if this bill and either or both AB 1949 and SB 944 are enacted and this bill is enacted last. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. The Legislature finds and declares all of the following: (a) In 2021, the State Department of Public Health (DPH) reported that California’s third graders have a substantially higher proportion of tooth decay compared to the national median of 53 percent. Children from communities of color and Spanish-speaking households are more likely to experience tooth decay. (b) Topical fluoride varnish is a simple, effective, and low-cost intervention that is painted on the top and sides of each tooth with a small brush in less than two minutes. According to the American Academy of Pediatrics, fluoride varnish can help prevent tooth decay, slow it down, or stop it from getting worse. Fluoride varnish is safe and used by dentists and doctors all over the world to help prevent tooth decay in children. It must be reapplied at regular intervals to be fully effective. The American Dental Association recommends the application of fluoride varnish twice annually for all children. (c) Although progress has been made to improve utilization, many children enrolled in Medi-Cal are not receiving regular dental services. Application of fluoride varnish outside dental settings offers an additional pathway for children to access this critical intervention. State Department of Health Care Services (DHCS) data published in May 2025 shows only 51.03 percent of children receiving dental services through the Medi-Cal Dental Fee-for-Service delivery system received at least one dental service in the 2024 calendar year. In the Counties of Los Angeles and Sacramento, fewer than one-half of all children receiving dental services through the Medi-Cal Dental Managed Care delivery system received at least one dental service in the 2024 calendar year. (d) DHCS has specifically identified the application of fluoride varnish to children 0 to 20, inclusive, years of age as an area for quality improvement within Medi-Cal. As part of the Managed Care Accountability Set, a set of performance metrics that DHCS selects for annual reporting by Medi-Cal managed care health plans, the state measures the percentage of children who had at least two applications of fluoride varnish in a single year as one of several key quality metrics. The Topical Fluoride for Children (TFL-CH) metric counts application of fluoride varnish in the dental and medical setting combined, for children 0 to 20, inclusive, years of age. As of April 2025, data shows most plans are below the Minimum Performance Level of 19.3 percent, meaning not even one in five Medi-Cal enrolled children is receiving fluoride varnish twice per year, as recommended, even when considering services provided in the dental setting and medical setting, combined. (e) The application of fluoride varnish must be covered by states as medically necessary for all children under 21 years of age enrolled in Medi-Cal, pursuant to federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Medicaid requirements. According to the federal Centers for Medicare and Medicaid Services: (1) Under EPSDT, states are required to provide any additional services that are coverable under the federal Medicaid program and found to be medically necessary to treat, correct, or reduce illnesses and conditions discovered regardless of whether the service is covered in a state’s Medicaid plan. (2) A determination of whether a service is medically necessary for an individual child must be made on a case-by-case basis, taking into account the particular needs of the child. (3) States may train primary care providers and pay them for oral health services, including fluoride varnish application. (4) Incorporating oral health into children’s primary care visits is a best-practice strategy. (5) It is about 10 times more expensive to provide inpatient dental care for caries-related conditions than to provide preventive care. (f) Consistent with EPSDT, “Medi-Cal for Kids and Teens,” a brochure published by DHCS describing EPSDT services, states that care covered by Medi-Cal for Kids and Teens includes all other needed services, as a child’s provider determines. (g) Current Medi-Cal policy printed in the Medi-Cal Provider Manual allows for the reimbursement of fluoride varnish in a primary care setting only for children zero to five, inclusive, years of age. (h) California law allows any person within a public health setting or a public health program created or administered by a federal, state, or local governmental entity to apply topical fluoride according to the prescription and protocol issued and established by a physician or dentist. This means that fluoride varnish can be applied by nonlicensed staff and lay workers that are overseen by a physician or dentist, including administrative staff, volunteers, community health workers, and other school- and community-based personnel. (i) Current Medi-Cal reimbursement policy requires a qualified health professional to apply topical fluoride varnish. (j) School-based fluoride varnish delivery programs are recommended as an evidence-based intervention by the Community Preventive Services Task Force, a federal entity created by the United States Department of Health and Human Services that makes evidence-based findings and recommendations about interventions to improve population health. (k) According to the Community Preventive Services Task Force, school-based fluoride varnish delivery programs may be administered by the school (e.g., school health center) or by outside entities (e.g., federally qualified health centers, state oral health programs, dental schools), and state Medicaid reimbursement policies regarding who can bill for preventive dental services and who can deliver them may pose greater barriers for nondental providers. (l) Lack of regular application of fluoride varnish results in more dental caries and worse oral health outcomes for children. (m) For applicable commercial health plans and insurance policies, the application of fluoride varnish is covered as an essential health benefit (EHB) under requirements for pediatric oral health coverage, pursuant to state and federal law for children under 19 years of age. (n) Pursuant to a United States Preventive Services Task Force (USPSTF) recommendation, the application of fluoride varnish in the primary care setting is specifically covered for zero to five, inclusive, years of age under a federal preventive services coverage requirement that applies to most private health plans. USPSTF recommends with a “B” grade that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. In its recommendation statement, the USPSTF states it only reviewed the evidence for preventive interventions of dental caries in children zero to five, inclusive, years of age. The USPSTF states that this should not be construed to imply that preventive interventions for dental caries should cease after five years of age. (o) Although older children are more likely than infants and toddlers to receive regular preventive care in a dental setting, the application of fluoride varnish outside a dental setting may be medically necessary for children who are not regularly receiving fluoride varnish in a dental setting. (p) Removal of fluoride from community water systems and recent federal action to remove ingestible fluoride prescription drug products for children from the market only increases the importance of ensuring widespread access to topical fluoride varnish. (q) It is the intent of the Legislature that expanding the type of personnel who can apply fluoride varnish in Medi-Cal and ensuring coverage of fluoride varnish outside of the dental setting for all children will create more opportunities to apply fluoride varnish within school-based and primary care settings, improve Medi-Cal quality metrics, and lead to fewer cavities, fewer school absences, and healthier California children. SEC. 2. Section 1367.73 is added to the Health and Safety Code, to read: 1367.73. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2027, that provides coverage for the application of fluoride varnish as a pediatric oral care benefit shall provide coverage for the application of fluoride varnish as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit, and shall not impose a deductible, coinsurance, copayment, or other cost-sharing requirement for that coverage. (b) This section does not apply to a specialized health care service plan contract, as defined in subdivision (o) of Section 1345, or a Medicare supplement contract. (c) Subdivision (a) does not diminish a plan’s responsibility under the federal Patient Protection and Affordable Care Act (Public Law 111-148) to cover services that are assigned either a grade of A or a grade of B by the United States Preventive Services Task Force for all populations subject to that recommendation. (d) If the requirements of subdivision (a) create an obligation for the state to defray costs for any individual, subdivision (a) shall cease to apply to a health care service plan subject to this section unless there is an appropriation in the annual Budget Act or other legislation for this purpose. (e) This section does not apply to Medi-Cal managed care plan contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code. SEC. 3. Section 10120.45 is added to the Insurance Code, to read: 10120.45. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, that provides coverage for the application of fluoride varnish as a pediatric oral care benefit shall provide coverage for the application of fluoride varnish as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit, and shall not impose a deductible, coinsurance, copayment, or other cost-sharing requirement for that coverage. (b) This section does not apply to a specialized health insurance policy, as defined in subdivision (c) of Section 106, or a Medicare supplement policy. (c) Subdivision (a) does not diminish an insurer’s responsibility under the federal Patient Protection and Affordable Care Act (Public Law 111-148) to cover services that are assigned either a [Text truncated for display. Full text available on Congress.gov.]