Summary
# Medicaid Dental Benefit Act of 2023 (H.R. 1342)
## WHAT THIS BILL DOES
This bill requires states to cover dental and oral health services for adults enrolled in Medicaid starting in 2025. The bill also creates quality measurement standards for adult dental care and directs the government to develop outreach programs about dental benefits.
## WHO IT AFFECTS
- Adults enrolled in Medicaid programs in the 50 states and Washington D.C.
- Adults in U.S. territories (Puerto Rico, Virgin Islands, Guam, Northern Mariana Islands, American Samoa)
- State Medicaid programs
- Dental and oral health care providers
- The federal government
## KEY PROVISIONS
- States must provide coverage of dentures, implants, and services to prevent oral disease, restore oral function, reduce pain, and treat emergency dental conditions to all Medicaid-eligible adults (Sec. 2(a)(2)(B))
- The federal government will pay 100 percent of costs for dental and oral health services for the 50 states and Washington D.C. for 12 quarters beginning January 1, 2025 (Sec. 2(c)(1)(A))
- The Secretary of Health and Human Services must develop a set of quality measures for adult oral health care and publish recommendations within one year of enactment (Sec. 3(b)(1))
- States must report annually on the dental benefits available to Medicaid adults, quality of care provided, and plans to reduce health disparities in oral health care (Sec. 3(c))
- The government must develop outreach and education programs about dental coverage for Medicaid-eligible adults within one year of enactment (Sec. 5)
## WHAT CHANGES
Starting January 1, 2025, Medicaid programs in all states and Washington D.C. must cover specific dental services for adults, including dentures, implants, and preventive care. The federal government will fully fund these services for the first three years. States must also begin collecting and reporting data on how well they deliver dental care to adults and track disparities by race, ethnicity, language, disability status, sexual orientation, and gender identity.
## IMPORTANT DEFINITIONS
The bill defines "dental and oral health services" as dentures and denture services, implants and implant services, and services necessary to prevent oral disease and promote oral health, restore oral structures to health and function, reduce oral pain, and treat emergency oral conditions. These services must be furnished by a provider legally authorized under state law.
## EFFECTIVE DATE
January 1, 2025 (Sec. 2(a)(1)(iii))
I
118TH CONGRESS
1ST SESSION H. R. 1342
To amend title XIX of the Social Security Act to improve coverage of
dental and oral health services for adults under Medicaid, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 3, 2023
Ms. BARRAGA´N (for herself, Mr. DOGGETT, and Mr. GRIJALVA) introduced the
following bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to improve
coverage of dental and oral health services for adults
under Medicaid, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Medicaid Dental Ben-
4
efit Act of 2023’’.
5
SEC. 2. REQUIRING MEDICAID COVERAGE OF DENTAL AND
6
ORAL HEALTH SERVICES FOR ADULTS.
7
(a) IN GENERAL.—
8
(1) MANDATORY COVERAGE.—
9
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(A) IN GENERAL.—
1
(i)
REQUIREMENT.—Section
2
1902(a)(10)(A) of the Social Security Act
3
(42 U.S.C. 1396a(a)(10)(A)), as amended
4
by section 11405(a)(1)(A) of Public Law
5
117–169, is amended by inserting ‘‘(10),’’
6
before ‘‘(13)(B),’’.
7
(ii) MEDICALLY NEEDY.—
8
(I)
IN
GENERAL.—Section
9
1902(a)(10)(C)(iv) of such Act (42
10
U.S.C.
1396a(a)(10)(C)(iv)),
as
11
amended by section 11405(a)(1)(B) of
12
Public Law 117–169, is amended by
13
inserting ‘‘(10),’’ before ‘‘(13)(B)’’.
14
(II) RULE OF CONSTRUCTION.—
15
Nothing in this section or the amend-
16
ments made by this section shall be
17
construed to limit the access of an in-
18
dividual residing in an institutional
19
setting to dental and oral health serv-
20
ices (as such term is defined in sec-
21
tion 1905(jj) of the Social Security
22
Act, as added by paragraph (2)(B)).
23
(iii) EFFECTIVE DATE.—The amend-
24
ments made by clauses (i) and (ii) shall
25
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•HR 1342 IH
apply with respect to expenditures for med-
1
ical assistance in calendar quarters begin-
2
ning on or after January 1, 2025.
3
(B)
BENCHMARK
COVERAGE.—Section
4
1937(b)(5) of the Social Security Act (42
5
U.S.C. 1396u–7(b)(5)) is amended by striking
6
the period and inserting ‘‘, and, beginning Jan-
7
uary 1, 2025, coverage of dental and oral
8
health services (as such term is defined in sec-
9
tion 1905(jj)).’’.
10
(C) OPTIONAL
APPLICATION
TO
TERRI-
11
TORIES.—Section 1902(j) of the Social Security
12
Act (42 U.S.C. 1396a(j)) is amended—
13
(i) by striking ‘‘this title, the Sec-
14
retary’’ and inserting ‘‘this title—
15
‘‘(1) in the case of a State other than the 50
16
States and the District of Columbia the requirement
17
under subsection (a)(10)(A) to provide the care and
18
services listed in paragraph (10) of section 1905(a)
19
shall be optional; and
20
‘‘(2) the Secretary’’; and
21
(ii) by striking the second comma
22
after ‘‘section 1108(f)’’.
23
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(2) DEFINITION OF DENTAL AND ORAL HEALTH
1
SERVICES.—Section 1905 of the Social Security Act
2
(42 U.S.C. 1396d) is amended—
3
(A) in subsection (a)(10), by inserting
4
‘‘and dental and oral health services (as defined
5
in subsection (jj))’’ after ‘‘dental services’’; and
6
(B) by adding at the end the following new
7
subsection:
8
‘‘(jj) DENTAL AND ORAL HEALTH SERVICES.—For
9
purposes of subsection (a)(10), the term ‘dental and oral
10
health services’ means dentures and denture services, im-
11
plants and implant services, and services necessary to pre-
12
vent oral disease and promote oral health, restore oral
13
structures to health and function, reduce oral pain, and
14
treat emergency oral conditions, that are furnished by a
15
provider who is legally authorized to furnish such items
16
and services under State law (or the State regulatory
17
mechanism provided by State law).’’.
18
(3) CONFORMING AMENDMENT.—
19
(A) IN GENERAL.—Section 1905(a)(10) of
20
the
Social
Security
Act
(42
U.S.C.
21
1396d(a)(10)), as amended by paragraph (2), is
22
amended by striking ‘‘dental services and’’.
23
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(B) EFFECTIVE
DATE.—The amendment
1
made by subparagraph (A) shall take effect on
2
January 1, 2025.
3
(b) STATE OPTION FOR ADDITIONAL DENTAL AND
4
ORAL HEALTH BENEFITS.—Section 1905(a)(13) of the
5
Social Security Act (42 U.S.C. 1396d(a)(13)) is amended
6
by inserting the following new subparagraph after sub-
7
paragraph (C):
8
‘‘(D) at State option, such items and serv-
9
ices related to dental and oral health services
10
(as defined in subsection (jj)) that are in addi-
11
tion to those identified in such subsection (jj)
12
as the State may specify;’’.
13
(c) INCREASED FMAP.—
14
(1) MEDICAID.—Section 1905 of the Social Se-
15
curity Act (42 U.S.C. 1396d), as amended by sub-
16
section (a), is further amended—
17
(A) in subsection (b), by striking ‘‘and
18
(ii)’’ and inserting ‘‘(ii), and (kk)’’;
19
(B) in subsection (ff), by striking ‘‘and
20
(ii)’’ and inserting ‘‘, (ii), and (kk)’’; and
21
(C) by adding at the end the following new
22
subsection:
23
‘‘(kk) INCREASED FMAP FOR EXPENDITURES RE-
24
LATED TO DENTAL AND ORAL HEALTH SERVICES.—
25
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•HR 1342 IH
‘‘(1) IN GENERAL.—
1
‘‘(A)
50
STATES
AND
DC.—Notwith-
2
standing subsection (b), in the case of a State
3
that is 1 of the 50 States or the District of Co-
4
lumbia, during the 12-quarter period that be-
5
gins on January 1, 2025, the Federal medical
6
assistance percentage shall be equal to 100 per-
7
cent with respect to amounts expended by the
8
State for medical assistance for dental and oral
9
health services authorized under paragraph (10)
10
of subsection (a). In no case may the applica-
11
tion of this subparagraph result in the Federal
12
medical assistance percentage determined for a
13
State with respect to expenditures described in
14
this subparagraph exceeding 100 percent.
15
‘‘(B) TERRITORIES.—
16
‘‘(i) IN
GENERAL.—Notwithstanding
17
subsection (b), in the case of a State that
18
is Puerto Rico, the Virgin Islands, Guam,
19
the Northern Mariana Islands, or Amer-
20
ican Samoa, during a period described in
21
clause (ii), the Federal medical assistance
22
percentage shall be equal to 100 percent
23
with respect to amounts expended by the
24
State for medical assistance for any item
25
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•HR 1342 IH
or service that is included in dental and
1
oral health services authorized under para-
2
graph (10) of subsection (a). In no case
3
may the application of this clause result in
4
the Federal medical assistance percentage
5
determined for a State with respect to ex-
6
penditures described in this clause exceed-
7
ing 100 percent.
8
‘‘(ii) PERIOD
DESCRIBED.—A period
9
described in this clause is, with respect to
10
an item or service described in clause (i)
11
and a State described in such clause, the
12
12-quarter period that begins with the first
13
quarter beginning on or after January 1,
14
2025, in which such item or service is first
15
covered under the State plan or under a
16
waiver of such plan.
17
‘‘(2) EXCLUSIONS.—The Federal medical as-
18
sistance percentage specified in paragraph (1) shall
19
not apply to amounts expended for medical assist-
20
ance during any period for—
21
‘‘(A) additional items and services author-
22
ized under paragraph (13)(D) of subsection (a);
23
or
24
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•HR 1342 IH
‘‘(B) items and services furnished to an in-
1
dividual if, as of the date of enactment of this
2
subsection, medical assistance was available to
3
such individual for such items and services or
4
medicare cost-sharing under the State plan or
5
a waiver of such plan.’’.
6
(2) EXCLUSION
OF
AMOUNTS
ATTRIBUTABLE
7
TO INCREASED FMAP FROM TERRITORIAL CAPS.—
8
Section 1108 of the Social Security Act (42 U.S.C.
9
1308) is amended—
10
(A) in subsection (f), in the matter pre-
11
ceding paragraph (1), by striking ‘‘subsections
12
(g) and (h)’’ and inserting ‘‘subsections (g),
13
(h), and (j)’’; and
14
(B) by adding at the end the following:
15
‘‘(j) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
16
UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN-
17
TAL
AND ORAL HEALTH SERVICES.—Any additional
18
amount paid to Puerto Rico, the Virgin Islands, Guam,
19
the Northern Mariana Islands, and American Samoa for
20
expenditures for medical assistance that is attributable to
21
an increase in the Federal medical assistance percentage
22
applicable to such expenditures under section 1905(kk)
23
shall not be taken into account for purposes of applying
24
payment limits under subsections (f) and (g).’’.
25
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•HR 1342 IH
SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEAS-
1
URES.
2
(a) IN GENERAL.—Title XI of the Social Security Act
3
(42 U.S.C. 1301 et seq.) is amended by inserting after
4
section 1139B the following new section:
5
‘‘SEC. 1139C. ADULT ORAL HEALTH QUALITY AND EQUITY
6
MEASURES.
7
‘‘(a) DEVELOPMENT OF CORE SET OF ADULT ORAL
8
HEALTH CARE QUALITY AND EQUITY MEASURES.—
9
‘‘(1) IN GENERAL.—The Secretary shall iden-
10
tify and publish a recommended core set of health
11
quality and equity measures for individuals enrolled
12
in a State plan (or waiver of such plan) under title
13
XIX who are over the age of 21 in the same manner
14
as the Secretary identifies and publishes a core set
15
of child health quality measures under section
16
1139A, including with respect to identifying and
17
publishing existing oral health quality measures for
18
such individuals that are in use under public and
19
privately sponsored health care coverage arrange-
20
ments, or that are part of reporting systems that
21
measure both the presence and duration of health
22
insurance coverage over time, that may be applicable
23
to enrolled adults.
24
‘‘(2) ALIGNMENT WITH EXISTING CORE SET.—
25
In identifying and publishing the recommended core
26
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•HR 1342 IH
set of adult oral health quality and equity measures
1
required under paragraph (1), the Secretary shall
2
ensure that, to the extent possible, such measures
3
align with and do not duplicate the core set of adult
4
health quality and equity measures identified, pub-
5
lished, and revised under section 1139B.
6
‘‘(3) PROCESS FOR ADULT ORAL HEALTH QUAL-
7
ITY AND EQUITY MEASURES PROGRAM.—In identi-
8
fying gaps in existing adult oral health quality and
9
equity measures and establishing priorities for the
10
development and advancement of such measures, the
11
Secretary shall consult with—
12
‘‘(A) States;
13
‘‘(B) health care providers;
14
‘‘(C) patient representatives;
15
‘‘(D) dental professionals; and
16
‘‘(E) national organizations with expertise
17
in oral health quality or equity measurement.
18
‘‘(b) DEADLINES.—
19
‘‘(1) RECOMMENDED
MEASURES.—Not later
20
than 1 year after enactment of this Act, the Sec-
21
retary shall identify and publish for comment a rec-
22
ommended core set of adult oral health quality and
23
equity measures that includes the following:
24
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•HR 1342 IH
‘‘(A) Measures of utilization of oral health
1
and dental services across health care settings.
2
‘‘(B) Measures that address the availability
3
of oral evaluations during or following medical
4
visits for enrolled adults.
5
‘‘(C) Measures that address the incidence
6
of emergency department visits for non-trau-
7
matic dental conditions.
8
‘‘(D) Measures that address the avail-
9
ability and receipt of follow-up dental care after
10
emergency department visits for non-traumatic
11
dental conditions during pregnancy.
12
‘‘(E) Measures that address the availability
13
of counseling of enrolled adults aimed at im-
14
proving oral health outcomes.
15
‘‘(F) Measures that address the availability
16
and receipt of care for beneficiaries who meet
17
the medical necessity criteria for general anes-
18
thesia and intravenous sedation.
19
‘‘(G) Measures that address screening and
20
evaluation for caries risk and periodontitis and
21
treatment for caries risk and periodontitis, in-
22
cluding the following:
23
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•HR 1342 IH
‘‘(i) The percentage of enrolled adults
1
who have caries risk documented in the re-
2
porting year involved.
3
‘‘(ii) The percentage of enrolled adults
4
who received a topical fluoride application
5
or sealants based on an oral health risk as-
6
sessment demonstrating the need for such
7
application or sealants during the report-
8
ing year involved.
9
‘‘(iii) The percentage of enrolled
10
adults who received a comprehensive or
11
periodic oral evaluation or a comprehensive
12
periodontal evaluation during the reporting
13
year involved.
14
‘‘(iv) The percentage of enrolled
15
adults with a history of periodontitis who
16
received an oral prophylaxis, scaling or
17
root planing, or periodontal maintenance
18
visit at least 2 times during the reporting
19
year involved.
20
‘‘(v) The percentage of enrolled adults
21
with diabetes who receive a comprehensive
22
or periodic evaluation or a comprehensive
23
periodontal evaluation during the reporting
24
year involved.
25
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•HR 1342 IH
‘‘(vi) The percentage of enrolled
1
adults who require tooth extraction during
2
the reporting year involved.
3
‘‘(vii) The percentage of enrolled
4
[Text truncated for display. Full text available on Congress.gov.]