II 

117TH CONGRESS 

1ST SESSION S. 3166 

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 

NOVEMBER 4, 2021 

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 2021’’. 

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)) is amended 

5 by inserting ‘‘(10),’’ after ‘‘(5),’’. 

6 (ii) MEDICALLY NEEDY.— 

7 (I) IN GENERAL.—Section 

8 1902(a)(10)(C)(iv) of such Act (42 

9 U.S.C. 1396a(a)(10)(C)(iv)) is 

10 amended by striking ‘‘and (17)’’ and 

11 inserting ‘‘, (10), and (17)’’ after 

12 ‘‘(5)’’. 

13 (II) RULE OF CONSTRUCTION.— 

14 Nothing in this section or the amend15 ments made by this section shall be 

16 construed to limit the access of an in17 dividual residing in an institutional 

18 setting to dental and oral health serv19 ices (as such term is defined in sec20 tion 1905(jj) of the Social Security 

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

22 (iii) EFFECTIVE DATE.—The amend23 ments made by clauses (i) and (ii) shall 

24 apply with respect to expenditures for medVerDate Sep 11 2014 04:04 Nov 05, 2021 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3166.IS S3166

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1 ical assistance in calendar quarters begin2 ning on or after January 1, 2023. 

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 Jan7 uary 1, 2023, coverage of dental and oral 

8 health services (as such term is defined in sec9 tion 1905(jj)).’’. 

10 (C) OPTIONAL APPLICATION TO TERRI11 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 Sec14 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 (2) DEFINITION OF DENTAL AND ORAL HEALTH

24 SERVICES.—Section 1905 of the Social Security Act 

25 (42 U.S.C. 1396d) is amended— 


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

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

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

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

5 subsection: 

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

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

8 health services’ means dentures and denture services, im9 plants and implant services, and services necessary to pre10 vent oral disease and promote oral health, restore oral 

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

12 treat emergency oral conditions, that are furnished by a 

13 provider who is legally authorized to furnish such items 

14 and services under State law (or the State regulatory 

15 mechanism provided by State law).’’. 

16 (3) CONFORMING AMENDMENT.— 

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

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

19 1396d(a)(10)), as amended by paragraph (2), is 

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

21 (B) EFFECTIVE DATE.—The amendment 

22 made by subparagraph (A) shall take effect on 

23 January 1, 2023. 

24 (b) STATE OPTION FOR ADDITIONAL DENTAL AND

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


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

2 by inserting the following new subparagraph after sub3 paragraph (C): 

4 ‘‘(D) at State option, such items and serv5 ices related to dental and oral health services 

6 (as defined in subsection (jj)) that are in addi7 tion to those identified in such subsection (jj) 

8 as the State may specify;’’. 

9 (c) INCREASED FMAP.— 

10 (1) MEDICAID.—Section 1905 of the Social Se11 curity Act (42 U.S.C. 1396d), as amended by sub12 section (a), is further amended— 

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

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

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

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

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

18 subsection: 

19 ‘‘(kk) INCREASED FMAP FOR EXPENDITURES RE20 LATED TO DENTAL AND ORAL HEALTH SERVICES.— 

21 ‘‘(1) IN GENERAL.— 

22 ‘‘(A) 50 STATES AND DC.—Notwith23 standing subsection (b), in the case of a State 

24 that is 1 of the 50 States or the District of Co25 lumbia, during the 12-quarter period that beVerDate Sep 11 2014 04:04 Nov 05, 2021 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3166.IS S3166

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1 gins on January 1, 2023, the Federal medical 

2 assistance percentage shall be equal to 100 per3 cent with respect to amounts expended by the 

4 State for medical assistance for dental and oral 

5 health services authorized under paragraph (10) 

6 of subsection (a). In no case may the applica7 tion of this subparagraph result in the Federal 

8 medical assistance percentage determined for a 

9 State with respect to expenditures described in 

10 this subparagraph exceeding 100 percent. 

11 ‘‘(B) TERRITORIES.— 

12 ‘‘(i) IN GENERAL.—Notwithstanding 

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

14 is Puerto Rico, the Virgin Islands, Guam, 

15 the Northern Mariana Islands, or Amer16 ican Samoa, during a period described in 

17 clause (ii), the Federal medical assistance 

18 percentage shall be equal to 100 percent 

19 with respect to amounts expended by the 

20 State for medical assistance for any item 

21 or service that is included in dental and 

22 oral health services authorized under para23 graph (10) of subsection (a). In no case 

24 may the application of this clause result in 

25 the Federal medical assistance percentage 


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1 determined for a State with respect to ex2 penditures described in this clause exceed3 ing 100 percent. 

4 ‘‘(ii) PERIOD DESCRIBED.—A period 

5 described in this clause is, with respect to 

6 an item or service described in clause (i) 

7 and a State described in such clause, the 

8 12-quarter period that begins with the first 

9 quarter beginning on or after January 1, 

10 2023, in which such item or service is first 

11 covered under the State plan or under a 

12 waiver of such plan. 

13 ‘‘(2) EXCLUSIONS.—The Federal medical as14 sistance percentage specified in paragraph (1) shall 

15 not apply to amounts expended for medical assist16 ance during any period for— 

17 ‘‘(A) additional items and services author18 ized under paragraph (13)(D) of subsection (a); 

19 or 

20 ‘‘(B) items and services furnished to an in21 dividual if, as of the date of enactment of this 

22 subsection, medical assistance was available to 

23 such individual for such items and services or 

24 medicare cost-sharing under the State plan or 

25 a waiver of such plan.’’. 


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1 (2) EXCLUSION OF AMOUNTS ATTRIBUTABLE

2 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 

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

4 1308) is amended— 

5 (A) in subsection (f), in the matter pre6 ceding paragraph (1), by striking ‘‘subsections 

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

8 (h), and (i)’’; and 

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

10 ‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB11 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN12 TAL AND ORAL HEALTH SERVICES.—Any additional 

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

14 the Northern Mariana Islands, and American Samoa for 

15 expenditures for medical assistance that is attributable to 

16 an increase in the Federal medical assistance percentage 

17 applicable to such expenditures under section 1905(kk) 

18 shall not be taken into account for purposes of applying 

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

20 SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEAS21 URES. 

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

23 (42 U.S.C. 1301 et seq.) is amended by inserting after 

24 section 1139B the following new section: 


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

2 MEASURES. 

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

4 HEALTH CARE QUALITY AND EQUITY MEASURES.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall iden6 tify and publish a recommended core set of health 

7 quality and equity measures for individuals enrolled 

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

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

10 as the Secretary identifies and publishes a core set 

11 of child health quality measures under section 

12 1139A, including with respect to identifying and 

13 publishing existing oral health quality measures for 

14 such individuals that are in use under public and 

15 privately sponsored health care coverage arrange16 ments, or that are part of reporting systems that 

17 measure both the presence and duration of health 

18 insurance coverage over time, that may be applicable 

19 to enrolled adults. 

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

21 In identifying and publishing the recommended core 

22 set of adult oral health quality and equity measures 

23 required under paragraph (1), the Secretary shall 

24 ensure that, to the extent possible, such measures 

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


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1 health quality and equity measures identified, pub2 lished, and revised under section 1139B. 

3 ‘‘(3) PROCESS FOR ADULT ORAL HEALTH QUAL4 ITY AND EQUITY MEASURES PROGRAM.—In identi5 fying gaps in existing adult oral health quality and 

6 equity measures and establishing priorities for the 

7 development and advancement of such measures, the 

8 Secretary shall consult with— 

9 ‘‘(A) States; 

10 ‘‘(B) health care providers; 

11 ‘‘(C) patient representatives; 

12 ‘‘(D) dental professionals; and 

13 ‘‘(E) national organizations with expertise 

14 in oral health quality or equity measurement. 

15 ‘‘(b) DEADLINES.— 

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

17 than 1 year after enactment of this Act, the Sec18 retary shall identify and publish for comment a rec19 ommended core set of adult oral health quality and 

20 equity measures that includes the following: 

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

22 and dental services across health care settings. 

23 ‘‘(B) Measures that address the availability 

24 of oral evaluations during or following medical 

25 visits for enrolled adults. 


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1 ‘‘(C) Measures that address the incidence 

2 of emergency department visits for non-trau3 matic dental conditions. 

4 ‘‘(D) Measures that address the avail5 ability and receipt of follow-up dental care after 

6 emergency department visits for non-traumatic 

7 dental conditions during pregnancy. 

8 ‘‘(E) Measures that address the availability 

9 of counseling of enrolled adults aimed at im10 proving oral health outcomes. 

11 ‘‘(F) Measures that address the availability 

12 and receipt of care for beneficiaries who meet 

13 the medical necessity criteria for general anes14 thesia and intravenous sedation. 

15 ‘‘(G) Measures that address screening and 

16 evaluation for caries risk and periodontitis and 

17 treatment for caries risk and periodontitis, in18 cluding the following: 

19 ‘‘(i) The percentage of enrolled adults 

20 who have caries risk documented in the re21 porting year involved. 

22 ‘‘(ii) The percentage of enrolled adults 

23 who received a topical fluoride application 

24 or sealants based on an oral health risk as25 sessment demonstrating the need for such 


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1 application or sealants during the report2 ing year involved. 

3 ‘‘(iii) The percentage of enrolled 

4 adults who received a comprehensive or 

5 periodic oral evaluation or a comprehensive 

6 periodontal evaluation during the reporting 

7 year involved. 

8 ‘‘(iv) The percentage of enrolled 

9 adults with a history of periodontitis who 

10 received an oral prophylaxis, scaling or 

11 root planing, or periodontal maintenance 

12 visit at least 2 times during the reporting 

13 year involved. 

14 ‘‘(v) The percentage of enrolled adults 

15 with diabetes who receive a comprehensive 

16 or periodic evaluation or a comprehensive 

17 periodontal evaluation during the reporting 

18 year involved. 

19 ‘‘(vi) The percentage of enrolled 

20 adults who require tooth extraction during 

21 the reporting year involved. 

22 ‘‘(vii) The percentage of enrolled 

23 adults who require partial or full dentures 

24 during the reporting year involved. 


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

2 after enactment of this Act, the Secretary shall pub3 lish an initial core set of oral health quality and eq4 uity measures that are applicable to enrolled adults. 

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

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

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

8 develop a standardized format for the collection and 

9 reporting of information based on the initial core set 

10 of adult oral health quality and equity measures 

11 (stratified by race, ethnicity, primary language, dis12 ability status, sexual orientation and gender iden13 tity) and create guidelines, procedures, and incen14 tives to States to use such measures and to collect 

15 and report information regarding the quality and eq16 uity of oral health care for enrolled adults. 

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

18 3 years after enactment of this act, and every 3 

19 years thereafter, the Secretary shall include in the 

20 report to Congress required under section 

21 1139A(a)(6) information similar to the information 

22 required under that section with respect to the 

23 measures established under this section. 


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1 ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE2 SPECIFIC ORAL HEALTH QUALITY AND EQUITY MEAS3 URES APPLIED UNDER MEDICAID.— 

4 ‘‘(1) IN GENERAL.—Each State with a plan ap5 proved under title XIX (or with a waiver of such 

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

7 part of the annual report required under section 

8 1139A(c)) to the Secretary on— 

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

10 quality and equity measures applied by the 

11 State under such a plan or waiver, including 

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

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

14 quality and equity of oral health care furnished 

15 to enrolled adults under such a plan or waiver, 

16 including information collected through external 

17 quality reviews of managed care organizations 

18 under section 1932 and benchmark plans under 

19 section 1937, disaggregated by race, ethnicity, 

20 primary language, disability status, sexual ori21 entation, and gender identity; 

22 ‘‘(C) the State-specific information regard23 ing the dental benefits available to enrolled 

24 adults under such a plan or waiver, including 

25 any limits on such benefits and the amount of 


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1 reimbursement provided under such plan or 

2 waiver for such benefits; and 

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

4 evaluate, and reduce in meaningful and measur5 able ways, to the extent practicable, health dis6 parities based on age, sex, race, ethnicity, pri7 mary language, sexual orientation and gender 

8 identity, and disability status. 

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

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

11 thereafter, the Secretary shall collect, analyze, and 

12 make publicly available the information reported by 

13 States under paragraph (1). 

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

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

16 out this section. Funds appropriated under this subsection 

17 shall remain available until expended.’’. 

18 (b) REQUIRED REPORTING.— 

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

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

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

22 at the end; 

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

24 period and inserting ‘‘; and’’; and 


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

2 following new paragraph: 

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

4 section 1139C(c).’’. 

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

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

7 the end the following new subsection: 

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

9 health plan shall provide for the reporting required under 

10 section 1139C(c).’’. 

11 SEC. 4. ADULT ORAL HEALTH CARE REPORT. 

12 Not later than 2 years after the date of enactment 

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

14 Commission shall submit to Congress a report on issues 

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

16 and the territories, including— 

17 (1) the availability of adult oral health cov18 erage, and enrollment in such coverage; 

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

20 low-income women of childbearing age; 

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

22 including for racially diverse, ethnically diverse, and 

23 limited English proficient communities; 

24 (4) innovations and potential solutions to prob25 lems of access (including disparities in access) to 


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1 adult oral health care, including innovations that 

2 would expand access to such care beyond dental of3 fices; and 

4 (5) the impact of the amendments made by sec5 tion 2 and recommendations for improving reim6 bursement rates for such provider of dental and oral 

7 health services under the Medicaid program. 

8 SEC. 5. ORAL HEALTH OUTREACH AND EDUCATION. 

9 Not later than 1 year after the date of enactment 

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

11 implemented through contracts with entities that fund or 

12 provide oral health care, to provide— 

13 (1) culturally competent and linguistically ap14 propriate information on the availability and scope 

15 of oral health and dental coverage for adults who are 

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

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

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

19 (2) assistance in connecting adults and under20 served populations enrolled in such a plan (or waiv21 er) to oral health care; 

22 (3) education to dental, oral health, and med23 ical professionals to strengthen core competencies in 

24 delivering culturally competent oral health care to 

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


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1 individuals with physical and intellectual disabilities, 

2 pregnant and postpartum individuals, Alaskan-Na3 tive and American-Indian populations, and people 

4 living in urban, rural and, other underserved com5 munities; and 

6 (4) culturally competent and linguistically ap7 propriate interactive oral health education aimed at 

8 promoting good oral health practices for adults, in9 cluding racially and ethnically diverse Medicaid 

10 beneficiaries. 

Æ 


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