II 

118TH CONGRESS 

1ST SESSION S. 570 

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 SENATE OF THE UNITED STATES 

FEBRUARY 28, 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 XIX of the Social Security Act to improve 

coverage of dental and oral health services for adults 

under Medicaid, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid Dental Ben5 efit Act of 2023’’. 

6 SEC. 2. REQUIRING MEDICAID COVERAGE OF DENTAL AND 

7 ORAL HEALTH SERVICES FOR ADULTS. 

8 (a) IN GENERAL.— 

9 (1) MANDATORY COVERAGE.— 


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1 (A) IN GENERAL.— 

2 (i) REQUIREMENT.—Section 

3 1902(a)(10)(A) of the Social Security Act 

4 (42 U.S.C. 1396a(a)(10)(A)), as amended 

5 by section 11405(a)(1)(A) of Public Law 

6 117–169, is amended by inserting ‘‘(10),’’ 

7 before ‘‘(13)(B),’’. 

8 (ii) MEDICALLY NEEDY.— 

9 (I) IN GENERAL.—Section 

10 1902(a)(10)(C)(iv) of such Act (42 

11 U.S.C. 1396a(a)(10)(C)(iv)), as 

12 amended by section 11405(a)(1)(B) of 

13 Public Law 117–169, is amended by 

14 inserting ‘‘(10),’’ before ‘‘(13)(B)’’. 

15 (II) RULE OF CONSTRUCTION.— 

16 Nothing in this section or the amend17 ments made by this section shall be 

18 construed to limit the access of an in19 dividual residing in an institutional 

20 setting to dental and oral health serv21 ices (as such term is defined in sec22 tion 1905(jj) of the Social Security 

23 Act, as added by paragraph (2)(B)). 

24 (iii) EFFECTIVE DATE.—The amend25 ments made by clauses (i) and (ii) shall 


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1 apply with respect to expenditures for med2 ical assistance in calendar quarters begin3 ning on or after January 1, 2025. 

4 (B) BENCHMARK COVERAGE.—Section 

5 1937(b)(5) of the Social Security Act (42 

6 U.S.C. 1396u–7(b)(5)) is amended by striking 

7 the period and inserting ‘‘, and, beginning Jan8 uary 1, 2025, coverage of dental and oral 

9 health services (as such term is defined in sec10 tion 1905(jj)).’’. 

11 (C) OPTIONAL APPLICATION TO TERRI12 TORIES.—Section 1902(j) of the Social Security 

13 Act (42 U.S.C. 1396a(j)) is amended— 

14 (i) by striking ‘‘this title, the Sec15 retary’’ and inserting ‘‘this title— 

16 ‘‘(1) in the case of a State other than the 50 

17 States and the District of Columbia the requirement 

18 under subsection (a)(10)(A) to provide the care and 

19 services listed in paragraph (10) of section 1905(a) 

20 shall be optional; and 

21 ‘‘(2) the Secretary’’; and 

22 (ii) by striking the second comma 

23 after ‘‘section 1108(f)’’. 


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1 (2) DEFINITION OF DENTAL AND ORAL HEALTH

2 SERVICES.—Section 1905 of the Social Security Act 

3 (42 U.S.C. 1396d) is amended— 

4 (A) in subsection (a)(10), by inserting 

5 ‘‘and dental and oral health services (as defined 

6 in subsection (jj))’’ after ‘‘dental services’’; and 

7 (B) by adding at the end the following new 

8 subsection: 

9 ‘‘(jj) DENTAL AND ORAL HEALTH SERVICES.—For 

10 purposes of subsection (a)(10), the term ‘dental and oral 

11 health services’ means dentures and denture services, im12 plants and implant services, and services necessary to pre13 vent oral disease and promote oral health, restore oral 

14 structures to health and function, reduce oral pain, and 

15 treat emergency oral conditions, that are furnished by a 

16 provider who is legally authorized to furnish such items 

17 and services under State law (or the State regulatory 

18 mechanism provided by State law).’’. 

19 (3) CONFORMING AMENDMENT.— 

20 (A) IN GENERAL.—Section 1905(a)(10) of 

21 the Social Security Act (42 U.S.C. 

22 1396d(a)(10)), as amended by paragraph (2), is 

23 amended by striking ‘‘dental services and’’. 


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1 (B) EFFECTIVE DATE.—The amendment 

2 made by subparagraph (A) shall take effect on 

3 January 1, 2025. 

4 (b) STATE OPTION FOR ADDITIONAL DENTAL AND

5 ORAL HEALTH BENEFITS.—Section 1905(a)(13) of the 

6 Social Security Act (42 U.S.C. 1396d(a)(13)) is amended 

7 by inserting the following new subparagraph after sub8 paragraph (C): 

9 ‘‘(D) at State option, such items and serv10 ices related to dental and oral health services 

11 (as defined in subsection (jj)) that are in addi12 tion to those identified in such subsection (jj) 

13 as the State may specify;’’. 

14 (c) INCREASED FMAP.— 

15 (1) MEDICAID.—Section 1905 of the Social Se16 curity Act (42 U.S.C. 1396d), as amended by sub17 section (a), is further amended— 

18 (A) in subsection (b), by striking ‘‘and 

19 (ii)’’ and inserting ‘‘(ii), and (kk)’’; 

20 (B) in subsection (ff), by striking ‘‘and 

21 (ii)’’ and inserting ‘‘, (ii), and (kk)’’; and 

22 (C) by adding at the end the following new 

23 subsection: 

24 ‘‘(kk) INCREASED FMAP FOR EXPENDITURES RE25 LATED TO DENTAL AND ORAL HEALTH SERVICES.— 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) 50 STATES AND DC.—Notwith3 standing subsection (b), in the case of a State 

4 that is 1 of the 50 States or the District of Co5 lumbia, during the 12-quarter period that be6 gins on January 1, 2025, the Federal medical 

7 assistance percentage shall be equal to 100 per8 cent with respect to amounts expended by the 

9 State for medical assistance for dental and oral 

10 health services authorized under paragraph (10) 

11 of subsection (a). In no case may the applica12 tion of this subparagraph result in the Federal 

13 medical assistance percentage determined for a 

14 State with respect to expenditures described in 

15 this subparagraph exceeding 100 percent. 

16 ‘‘(B) TERRITORIES.— 

17 ‘‘(i) IN GENERAL.—Notwithstanding 

18 subsection (b), in the case of a State that 

19 is Puerto Rico, the Virgin Islands, Guam, 

20 the Northern Mariana Islands, or Amer21 ican Samoa, during a period described in 

22 clause (ii), the Federal medical assistance 

23 percentage shall be equal to 100 percent 

24 with respect to amounts expended by the 

25 State for medical assistance for any item 


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1 or service that is included in dental and 

2 oral health services authorized under para3 graph (10) of subsection (a). In no case 

4 may the application of this clause result in 

5 the Federal medical assistance percentage 

6 determined for a State with respect to ex7 penditures described in this clause exceed8 ing 100 percent. 

9 ‘‘(ii) PERIOD DESCRIBED.—A period 

10 described in this clause is, with respect to 

11 an item or service described in clause (i) 

12 and a State described in such clause, the 

13 12-quarter period that begins with the first 

14 quarter beginning on or after January 1, 

15 2025, in which such item or service is first 

16 covered under the State plan or under a 

17 waiver of such plan. 

18 ‘‘(2) EXCLUSIONS.—The Federal medical as19 sistance percentage specified in paragraph (1) shall 

20 not apply to amounts expended for medical assist21 ance during any period for— 

22 ‘‘(A) additional items and services author23 ized under paragraph (13)(D) of subsection (a); 

24 or 


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1 ‘‘(B) items and services furnished to an in2 dividual if, as of the date of enactment of this 

3 subsection, medical assistance was available to 

4 such individual for such items and services or 

5 medicare cost-sharing under the State plan or 

6 a waiver of such plan.’’. 

7 (2) EXCLUSION OF AMOUNTS ATTRIBUTABLE

8 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 

9 Section 1108 of the Social Security Act (42 U.S.C. 

10 1308) is amended— 

11 (A) in subsection (f), in the matter pre12 ceding paragraph (1), by striking ‘‘subsections 

13 (g) and (h)’’ and inserting ‘‘subsections (g), 

14 (h), and (j)’’; and 

15 (B) by adding at the end the following: 

16 ‘‘(j) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB17 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN18 TAL AND ORAL HEALTH SERVICES.—Any additional 

19 amount paid to Puerto Rico, the Virgin Islands, Guam, 

20 the Northern Mariana Islands, and American Samoa for 

21 expenditures for medical assistance that is attributable to 

22 an increase in the Federal medical assistance percentage 

23 applicable to such expenditures under section 1905(kk) 

24 shall not be taken into account for purposes of applying 

25 payment limits under subsections (f) and (g).’’. 


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1 SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEAS2 URES. 

3 (a) IN GENERAL.—Title XI of the Social Security Act 

4 (42 U.S.C. 1301 et seq.) is amended by inserting after 

5 section 1139B the following new section: 

6 ‘‘SEC. 1139C. ADULT ORAL HEALTH QUALITY AND EQUITY 

7 MEASURES. 

8 ‘‘(a) DEVELOPMENT OF CORE SET OF ADULT ORAL

9 HEALTH CARE QUALITY AND EQUITY MEASURES.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall iden11 tify and publish a recommended core set of health 

12 quality and equity measures for individuals enrolled 

13 in a State plan (or waiver of such plan) under title 

14 XIX who are over the age of 21 in the same manner 

15 as the Secretary identifies and publishes a core set 

16 of child health quality measures under section 

17 1139A, including with respect to identifying and 

18 publishing existing oral health quality measures for 

19 such individuals that are in use under public and 

20 privately sponsored health care coverage arrange21 ments, or that are part of reporting systems that 

22 measure both the presence and duration of health 

23 insurance coverage over time, that may be applicable 

24 to enrolled adults. 

25 ‘‘(2) ALIGNMENT WITH EXISTING CORE SET.— 

26 In identifying and publishing the recommended core 


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1 set of adult oral health quality and equity measures 

2 required under paragraph (1), the Secretary shall 

3 ensure that, to the extent possible, such measures 

4 align with and do not duplicate the core set of adult 

5 health quality and equity measures identified, pub6 lished, and revised under section 1139B. 

7 ‘‘(3) PROCESS FOR ADULT ORAL HEALTH QUAL8 ITY AND EQUITY MEASURES PROGRAM.—In identi9 fying gaps in existing adult oral health quality and 

10 equity measures and establishing priorities for the 

11 development and advancement of such measures, the 

12 Secretary shall consult with— 

13 ‘‘(A) States; 

14 ‘‘(B) health care providers; 

15 ‘‘(C) patient representatives; 

16 ‘‘(D) dental professionals; and 

17 ‘‘(E) national organizations with expertise 

18 in oral health quality or equity measurement. 

19 ‘‘(b) DEADLINES.— 

20 ‘‘(1) RECOMMENDED MEASURES.—Not later 

21 than 1 year after enactment of this Act, the Sec22 retary shall identify and publish for comment a rec23 ommended core set of adult oral health quality and 

24 equity measures that includes the following: 


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1 ‘‘(A) Measures of utilization of oral health 

2 and dental services across health care settings. 

3 ‘‘(B) Measures that address the availability 

4 of oral evaluations during or following medical 

5 visits for enrolled adults. 

6 ‘‘(C) Measures that address the incidence 

7 of emergency department visits for non-trau8 matic dental conditions. 

9 ‘‘(D) Measures that address the avail10 ability and receipt of follow-up dental care after 

11 emergency department visits for non-traumatic 

12 dental conditions during pregnancy. 

13 ‘‘(E) Measures that address the availability 

14 of counseling of enrolled adults aimed at im15 proving oral health outcomes. 

16 ‘‘(F) Measures that address the availability 

17 and receipt of care for beneficiaries who meet 

18 the medical necessity criteria for general anes19 thesia and intravenous sedation. 

20 ‘‘(G) Measures that address screening and 

21 evaluation for caries risk and periodontitis and 

22 treatment for caries risk and periodontitis, in23 cluding the following: 


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1 ‘‘(i) The percentage of enrolled adults 

2 who have caries risk documented in the re3 porting year involved. 

4 ‘‘(ii) The percentage of enrolled adults 

5 who received a topical fluoride application 

6 or sealants based on an oral health risk as7 sessment demonstrating the need for such 

8 application or sealants during the report9 ing year involved. 

10 ‘‘(iii) The percentage of enrolled 

11 adults who received a comprehensive or 

12 periodic oral evaluation or a comprehensive 

13 periodontal evaluation during the reporting 

14 year involved. 

15 ‘‘(iv) The percentage of enrolled 

16 adults with a history of periodontitis who 

17 received an oral prophylaxis, scaling or 

18 root planing, or periodontal maintenance 

19 visit at least 2 times during the reporting 

20 year involved. 

21 ‘‘(v) The percentage of enrolled adults 

22 with diabetes who receive a comprehensive 

23 or periodic evaluation or a comprehensive 

24 periodontal evaluation during the reporting 

25 year involved. 


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1 ‘‘(vi) The percentage of enrolled 

2 adults who require tooth extraction during 

3 the reporting year involved. 

4 ‘‘(vii) The percentage of enrolled 

5 adults who require partial or full dentures 

6 during the reporting year involved. 

7 ‘‘(2) DISSEMINATION.—Not later than 1 year 

8 after enactment of this Act, the Secretary shall pub9 lish an initial core set of oral health quality and eq10 uity measures that are applicable to enrolled adults. 

11 ‘‘(3) STANDARDIZED REPORTING.—Not later 

12 than 2 years after the date of the enactment of this 

13 Act, the Secretary, in consultation with States, shall 

14 develop a standardized format for the collection and 

15 reporting of information based on the initial core set 

16 of adult oral health quality and equity measures 

17 (stratified by race, ethnicity, primary language, dis18 ability status, sexual orientation and gender iden19 tity) and create guidelines, procedures, and incen20 tives to States to use such measures and to collect 

21 and report information regarding the quality and eq22 uity of oral health care for enrolled adults. 

23 ‘‘(4) REPORTS TO CONGRESS.—Not later than 

24 3 years after enactment of this act, and every 3 

25 years thereafter, the Secretary shall include in the 


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1 report to Congress required under section 

2 1139A(a)(6) information similar to the information 

3 required under that section with respect to the 

4 measures established under this section. 

5 ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE6 SPECIFIC ORAL HEALTH QUALITY AND EQUITY MEAS7 URES APPLIED UNDER MEDICAID.— 

8 ‘‘(1) IN GENERAL.—Each State with a plan ap9 proved under title XIX (or with a waiver of such 

10 plan in effect) shall annually report (separately or as 

11 part of the annual report required under section 

12 1139A(c)) to the Secretary on— 

13 ‘‘(A) the State-specific adult oral health 

14 quality and equity measures applied by the 

15 State under such a plan or waiver, including 

16 measures described in subsection (b)(1); 

17 ‘‘(B) the State-specific information on the 

18 quality and equity of oral health care furnished 

19 to enrolled adults under such a plan or waiver, 

20 including information collected through external 

21 quality reviews of managed care organizations 

22 under section 1932 and benchmark plans under 

23 section 1937, disaggregated by race, ethnicity, 

24 primary language, disability status, sexual ori25 entation, and gender identity; 


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1 ‘‘(C) the State-specific information regard2 ing the dental benefits available to enrolled 

3 adults under such a plan or waiver, including 

4 any limits on such benefits and the amount of 

5 reimbursement provided under such plan or 

6 waiver for such benefits; and 

7 ‘‘(D) the State-specific plan to identify, 

8 evaluate, and reduce in meaningful and measur9 able ways, to the extent practicable, health dis10 parities based on age, sex, race, ethnicity, pri11 mary language, sexual orientation and gender 

12 identity, and disability status. 

13 ‘‘(2) PUBLICATION.—Not later than 2 years 

14 after the date of enactment of this Act, and annually 

15 thereafter, the Secretary shall collect, analyze, and 

16 make publicly available the information reported by 

17 States under paragraph (1). 

18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated $10,000,000 to carry 

20 out this section. Funds appropriated under this subsection 

21 shall remain available until expended.’’. 

22 (b) REQUIRED REPORTING.— 

23 (1) MEDICAID.—Section 1902(a) of the Social 

24 Security Act (42 U.S.C. 1396a(a)) is amended— 


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1 (A) in paragraph (86), by striking ‘‘and’’ 

2 at the end; 

3 (B) in paragraph (87)(D), by striking the 

4 period and inserting ‘‘; and’’; and 

5 (C) by inserting after paragraph (87) the 

6 following new paragraph: 

7 ‘‘(88) provide for the reporting required under 

8 section 1139C(c).’’. 

9 (2) CHIP.—Section 2102 of the Social Security 

10 Act (42 U.S.C. 1397bb) is amended by adding at 

11 the end the following new subsection: 

12 ‘‘(d) REPORTING REQUIREMENTS.—A State child 

13 health plan shall provide for the reporting required under 

14 section 1139C(c).’’. 

15 SEC. 4. ADULT ORAL HEALTH CARE REPORT. 

16 Not later than 2 years after the date of enactment 

17 of this Act, the Medicaid and CHIP Payment and Access 

18 Commission shall submit to Congress a report on issues 

19 related to adult oral health across the 50 States, tribes, 

20 and the territories, including— 

21 (1) the availability of adult oral health cov22 erage, and enrollment in such coverage; 

23 (2) a survey of adult oral health status among 

24 low-income women of childbearing age; 


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1 (3) barriers to accessing adult oral health care, 

2 including for racially diverse, ethnically diverse, and 

3 limited English proficient communities; 

4 (4) innovations and potential solutions to prob5 lems of access (including disparities in access) to 

6 adult oral health care, including innovations that 

7 would expand access to such care beyond dental of8 fices; and 

9 (5) the impact of the amendments made by sec10 tion 2 and recommendations for improving reim11 bursement rates for such provider of dental and oral 

12 health services under the Medicaid program. 

13 SEC. 5. ORAL HEALTH OUTREACH AND EDUCATION. 

14 Not later than 1 year after the date of enactment 

15 of this Act, the Secretary shall develop a program, to be 

16 implemented through contracts with entities that fund or 

17 provide oral health care, to provide— 

18 (1) culturally competent and linguistically ap19 propriate information on the availability and scope 

20 of oral health and dental coverage for adults who are 

21 eligible for or enrolled under a State plan (or waiver 

22 of such plan) under title XIX of the Social Security 

23 Act (42 U.S.C. 1396 et seq.); 


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1 (2) assistance in connecting adults and under2 served populations enrolled in such a plan (or waiv3 er) to oral health care; 

4 (3) education to dental, oral health, and med5 ical professionals to strengthen core competencies in 

6 delivering culturally competent oral health care to 

7 adults enrolled in such a plan (or waiver), including: 

8 individuals with physical and intellectual disabilities, 

9 pregnant and postpartum individuals, Alaskan Na10 tive and American Indian populations, and people 

11 living in urban, rural and, other underserved com12 munities; and 

13 (4) culturally competent and linguistically ap14 propriate interactive oral health education aimed at 

15 promoting good oral health practices for adults, in16 cluding racially and ethnically diverse Medicaid 

17 beneficiaries. 

Æ 


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