What This Bill Does
This bill changes the Children's Health Insurance Program (CHIP) by preventing states from limiting how much dental coverage children can receive. The bill also requires states to offer additional dental-only coverage to certain children who need it.
Who It Affects
- States that run CHIP programs
- Children enrolled in CHIP (called "targeted low-income children" in the bill)
- Pregnant women enrolled in CHIP if the state provides pregnancy-related assistance
Key Provisions
- States cannot set lifetime limits or yearly dollar limits on dental benefits for children in CHIP (Sec. 2)
- States cannot set lifetime limits or yearly dollar limits on dental benefits for pregnant women in CHIP who receive pregnancy-related assistance (Sec. 2)
- States must offer dental-only supplemental coverage to children in CHIP (Sec. 3)
What Changes
If this bill becomes law, states can no longer cap the amount of dental care children receive through CHIP by setting yearly or lifetime spending limits. States will also be required to provide additional dental coverage to children who need it, rather than treating this as optional.
Important Definitions
"Targeted low-income child" - Not specified in bill text
Effective Date
Six months after the bill becomes law
II
118TH CONGRESS
1ST SESSION
S. 109
To amend title XXI of the Social Security Act to prohibit lifetime or annual
limits on dental coverage under the Children’s Health Insurance Pro-
gram, and to require wraparound coverage of dental services for certain
children under such program.
IN THE SENATE OF THE UNITED STATES
JANUARY 26, 2023
Mr. CARDIN (for himself and Ms. STABENOW) introduced the following bill;
which was read twice and referred to the Committee on Finance
A BILL
To amend title XXI of the Social Security Act to prohibit
lifetime or annual limits on dental coverage under the
Children’s Health Insurance Program, and to require
wraparound coverage of dental services for certain chil-
dren under such program.
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 ‘‘Ensuring Kids Have
4
Access to Medically Necessary Dental Care Act’’.
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•S 109 IS
SEC. 2. PROHIBITION OF LIFETIME OR ANNUAL LIMITS ON
1
DENTAL BENEFITS UNDER THE CHILDREN’S
2
HEALTH INSURANCE PROGRAM.
3
(a) IN GENERAL.—Section 2103(c)(6) of the Social
4
Security Act (42 U.S.C. 1397cc(c)(6)) is amended—
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(1) in subparagraph (A), by inserting ‘‘, subject
6
to subparagraph (D),’’ after ‘‘shall include’’;
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(2) in subparagraph (B), by striking ‘‘A State’’
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and inserting ‘‘Subject to subparagraph (D), a
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State’’; and
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(3) by adding at the end the following new sub-
11
paragraph:
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‘‘(D) NO LIFETIME OR ANNUAL LIMITS ON
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DENTAL BENEFITS.—A State shall not establish
14
lifetime or annual limits on the dollar value of
15
benefits for dental services provided under the
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State child health plan to a targeted low-income
17
child, and, in the case that the State elects to
18
provide pregnancy-related assistance pursuant
19
to section 2112, to a targeted low-income preg-
20
nant woman (as defined in section 2112(d)), in-
21
cluding benefits for such services that are pro-
22
vided through dental coverage that is otherwise
23
equivalent to a benchmark dental package de-
24
scribed in subparagraph (C).’’.
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•S 109 IS
(b) EFFECTIVE DATE.—The amendments made by
1
this section shall take effect on the date that is 6 months
2
after the date of enactment of this Act.
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SEC. 3. REQUIRING WRAPAROUND COVERAGE OF DENTAL
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SERVICES FOR CERTAIN CHILDREN UNDER
5
CHIP.
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(a) IN GENERAL.—Section 2110(b)(5) of the Social
7
Security Act (42 U.S.C. 1397jj(b)(5)) is amended—
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(1) in the paragraph header, by striking ‘‘OP-
9
TION’’ and inserting ‘‘REQUIREMENT’’;
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(2) in subparagraph (A), by striking ‘‘may
11
waive’’ and inserting ‘‘shall waive’’; and
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(3) in subparagraph (C)—
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(A) in the subparagraph header, by strik-
14
ing ‘‘CONDITIONS’’ and inserting ‘‘REQUIRE-
15
MENTS’’; and
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(B) by striking ‘‘may not offer dental-only
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supplemental coverage under this paragraph
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unless the State satisfies the following condi-
19
tions’’ and inserting ‘‘shall offer dental-only
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supplemental coverage under this paragraph in
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accordance with the following requirements’’.
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•S 109 IS
(b) EFFECTIVE DATE.—The amendments made by
1
this section shall take effect on the date that is 6 months
2
after the date of enactment of this Act.
3
Æ
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