Health care coverage: fluoride treatments.

Header changed from amendment history (listing five prior amendment dates) to enrolled format showing passage dates of August 26, 2026 in both houses and a blank line for the Governor's receipt date.

Author and coauthor information (Assembly Member Bonta, Assembly Member Jackson, Senator Rubio) was removed from the enrolled version header.

The legislative counsel's digest dropped the phrase 'as amended' from the bill title reference, reflecting that this is now the final enrolled text rather than an amended draft.

The effective date for requiring private health care service plan contracts and health insurance policies to cover fluoride varnish without cost sharing was changed from 'January 1, 2026, 2027' to only 'January 1, 2027,' eliminating the earlier 2026 date.

The Medi-Cal requirement was consolidated: previously DHCS had to establish and promulgate a policy by January 1, 2027 AND issue billing guidance by July 1, 2027. Now there is a single requirement for DHCS to issue billing guidance and make necessary updates no later than July 1, 2027 to ensure coverage policy is consistent with federal EPSDT benefits and allows fluoride varnish application.

A new fiscal note paragraph was added stating that the bill incorporates additional changes to Section 14132 of the Welfare and Institutions Code proposed by AB 1949 and SB 944, operative only if this bill and either or both companion bills are enacted and this bill is enacted last.

The effective date for the commercial health plan and insurance policy coverage requirement was delayed by one year, from January 1, 2026 to January 1, 2027.

The deadline for DHCS to issue Medi-Cal billing guidance was changed from January 1, 2027 to July 1, 2027, and the requirement was reframed from establishing a new billing policy to issuing guidance and updates ensuring consistency with federal EPSDT benefits.

The coverage requirement was broadened: it no longer applies only to fluoride varnish in the primary care setting for children under 21. Instead, it now applies to any plan that already provides fluoride varnish as a pediatric oral care benefit, requiring that benefit to be covered as medically necessary regardless of whether billed as dental or medical.

A new exemption was added (subdivision (e) of Section 1367.73) excluding Medi-Cal managed care plan contracts with DHCS under specific Welfare and Institutions Code chapters from the commercial plan coverage requirement.

The Medi-Cal benefit description removed the explicit phrase 'including fluoride varnish' from the general fluoride treatment coverage language, though fluoride varnish remains referenced in the billing guidance requirement.

Commercial health plans and insurance policies must now cover fluoride varnish 'as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit,' replacing the prior requirement that it be billed specifically as a medical benefit. This broadens coverage by eliminating the billing-category restriction.

The Medi-Cal billing policy requirement was restructured into two specific sub-requirements: (A) a policy specifying fluoride varnish is covered as medically necessary regardless of dental or medical billing category, and (B) a policy allowing reimbursement when applied by persons employed by or in contractual relationship with the provider or otherwise authorized under law.

The exemption for specialized plans was narrowed. The old version exempted 'a specialized health care service plan contract that covers dental or vision benefits.' The new version exempts only 'a specialized health care service plan contract, as defined in subdivision (o) of Section 1345,' removing the qualifier about covering dental or vision benefits.

An extensive new Section 1 containing legislative findings and declarations was added, documenting California's high tooth decay rates, low Medi-Cal dental utilization (51.03%), quality metric performance below minimum levels (19.3%), federal EPSDT mandates, current policy limitations, legal authority for non-licensed applicators, and the impact of fluoride removal from water systems.

A new subdivision (d) was added to both the Health and Safety Code and Insurance Code provisions stating that if the coverage requirement creates an obligation for the state to defray costs for any individual, the requirement ceases to apply unless there is an appropriation in the annual Budget Act or other legislation.

A specific deadline of 'no later than January 1, 2027' was added for the State Department of Health Care Services to establish and promulgate its billing policy for fluoride varnish under Medi-Cal, replacing the prior open-ended requirement.

A new paragraph was added to the Medi-Cal section allowing the department to implement, interpret, or make specific the fluoride varnish provisions without further regulatory action through all-county letters, plan letters, plan or provider bulletins, or similar instructions.

Senator Rubio was added as a co-author alongside Assembly Members Bonta and Jackson.

Added cross-reference to subdivision (o) of Section 1345 for the definition of 'specialized health care service plan contract' in the exemption from cost-sharing requirements

Added cross-reference to subdivision (c) of Section 106 for the definition of 'specialized health insurance policy' in the exemption from cost-sharing requirements

Added new subdivision (q)(4) to the Medi-Cal schedule of benefits allowing dental hygiene services provided by registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice to be covered, as long as they fall within the scope of Denti-Cal benefits and are medically necessary

Added an exemption in Insurance Code Section 1367.73 stating that the fluoride varnish coverage requirement does not apply to specialized health care service plan contracts that cover dental or vision benefits or Medicare supplement policies.

Added a parallel exemption in Insurance Code Section 10120.45 stating that the fluoride varnish coverage requirement does not apply to specialized health insurance policies that cover dental or vision benefits or Medicare supplement policies.

Assembly Member Jackson added as coauthor of the bill.

Renumbered the existing ACA/USPSTF savings clause from subdivision (b) to subdivision (c) in both sections to accommodate the new exemption as subdivision (b).

Added a requirement that health care service plan contracts (Section 1367.73) and health insurance policies (Section 10120.45) must not impose any deductible, coinsurance, copayment, or other cost-sharing requirement for fluoride varnish coverage for children under 21.

Added language requiring that fluoride varnish application be billed as a medical benefit in both the health care service plan and insurance policy provisions, and in the Medi-Cal provision (Section 14132(q)(2)).

Corrected the Medi-Cal age range in Section 14132(q)(1) from 'children 17 years of age and under 21 years of age' to 'children under 21 years of age,' removing a confusing dual-age reference that likely was a drafting error.