Health care coverage: fluoride treatments.

Assembly Member Bonta's fluoride varnish coverage bill requires health plans and insurers to provide pediatric fluoride treatments without cost sharing, while expanding Medi-Cal coverage for these preventive dental services. Starting January 2026, health care service plans and insurance policies must cover medically necessary fluoride varnish applications regardless of whether they are billed as dental or medical benefits.

The legislation extends Medi-Cal coverage for fluoride treatments to beneficiaries under age 21, broadening the current policy that limits coverage to younger age groups. By January 2027, the Department of Health Care Services must establish billing policies allowing reimbursement when fluoride varnish is applied by qualified personnel employed by or contracted with Medi-Cal providers.

The bill includes provisions ensuring the requirements do not take effect if they would create state cost obligations without corresponding appropriations. Specialized health plans, Medicare supplement policies, and certain other coverage types are exempt from the new mandates. The Department of Health Care Services may implement the Medi-Cal provisions through administrative guidance while formal regulations are developed.