I 
109TH CONGRESS 
1ST SESSION 
H. R. 594
To amend titles XIX and XXI of the Social Security Act to provide for 
expanded dental coverage under Medicaid and State children’s health 
insurance programs and to provide for funding for expanded community 
oral health services. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 2, 2005
Mr. SANDERS (for himself, Mr. KILDEE, Mr. MEEHAN, Ms. LEE, Ms. WOOL-
SEY, Mr. HINCHEY, Ms. SOLIS, Mr. OLVER, Mr. NADLER, Mr. 
CUMMINGS, Mr. LEWIS of Georgia, Mr. DEFAZIO, Mr. ABERCROMBIE, 
Mr. KUCINICH, Mr. DAVIS of Illinois, Ms. WATSON, Mr. GUTIERREZ, and 
Ms. EDDIE BERNICE JOHNSON of Texas) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to provide for expanded dental coverage under Medicaid 
and State children’s health insurance programs and to 
provide for funding for expanded community oral health 
services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Oral Health Promotion 
Act of 2005’’.
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Oral and general health are inseparable, 
and good dental care is critical to our overall phys-
ical health and well-being, yet 108 million Americans 
have no public or private dental insurance. 
(2) Although oral health in America has im-
proved dramatically over the last 50 years, dental 
caries (cavities) are presently the single most com-
mon chronic childhood disease, five times more likely 
than asthma and seven times more common than 
hay fever. 
(3) According to the Surgeon General, low-in-
come, minority children experience significant dis-
parities in oral health status and access to basic 
dental care. In a year-long study, the Surgeon Gen-
eral found that fewer than one in five Medicaid-cov-
ered children received a single dental visit during 
that period and that 25 percent of poor and minor-
ity children never visit a dentist before entering kin-
dergarten. 
(4) Poor children are more than twice as likely 
than their more affluent peers to have dental caries, 
which cause a significant amount of pain to children 
and cause difficulty eating, playing and learning, as 
well as many missed days of school, and which are
more likely to go untreated. Surveys have shown 
that children miss nearly 52 million hours of school 
each year because of dental problems. 
(5) Low-income adults face similar problems 
with pain and limitations on daily activities and are 
more likely than those with higher incomes to lose 
permanent teeth and have untreated dental disease. 
Among adult workers, more than 164 million work 
hours are lost annually because of dental problems. 
SEC. 3. REQUIREMENT FOR DENTAL BENEFITS UNDER 
SCHIP. 
(a) IN GENERAL.—Section 2103(c)(2) of the Social 
Security Act (42 U.S.C. 1397cc(c)(2)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(E) Dental services.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on January 1, 2006. 
SEC. 4. AUTHORITY TO PROVIDE DENTAL COVERAGE 
UNDER SCHIP AS A SUPPLEMENT TO OTHER 
HEALTH COVERAGE. 
(a) AUTHORITY TO PROVIDE COVERAGE.—
(1) SCHIP.—
(A) IN GENERAL.—Section 2105(a)(1)(C) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397ee(a)(1)(C)) is amended—
(i) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(ii) notwithstanding clause (i), in the case 
of a State that satisfies the conditions described 
in subsection (c)(8) and at the option of a 
State, for child health assistance that consists 
only of coverage of dental services for a child 
who would be considered a targeted low-income 
child if—
‘‘(I) that portion of subparagraph (C) 
of section 2110(b)(1) relating to coverage 
of the child under a group health plan or 
under health insurance coverage did not 
apply, and such child has such coverage 
that does not include coverage of dental 
services; or 
‘‘(II) such child meets the require-
ments (other than income-related require-
ments) to be a targeted low-income child; 
and’’. 
(B) 
CONDITIONS
DESCRIBED.—Section 
2105(c) of such Act (42 U.S.C. 1397ee(c)) is 
amended by adding at the end the following:
‘‘(8) CONDITIONS FOR PROVISION OF DENTAL 
SERVICES ONLY COVERAGE.—For purposes of sub-
section (a)(1)(C)(ii), the conditions described in this 
paragraph are the following: 
‘‘(A) INCOME
ELIGIBILITY.—The State 
child health plan (whether implemented under 
title XIX or this title)—
‘‘(i) has the highest income eligibility 
standard permitted under this title as of 
January 1, 2005; 
‘‘(ii) subject to subparagraph (B), 
does not limit the acceptance of applica-
tions for children; and 
‘‘(iii) provides benefits to all children 
in the State who apply for and meet eligi-
bility standards. 
‘‘(B) NO WAITING LIST IMPOSED.—With 
respect to children whose family income is at or 
below 200 percent of the poverty line, the State 
does not impose any numerical limitation, wait-
ing list, or similar limitation on the eligibility of 
such children for child health assistance under 
such State plan.’’. 
(C) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—In addition to any funds otherwise au-
thorized to be appropriated, there are author-
ized to be appropriated such additional funds as 
may be necessary to carry out the amendments 
made by subparagraphs (A) and (B). 
(D) STATE OPTION TO WAIVE WAITING PE-
RIOD.—Section 2102(b)(1)(B) of such Act (42 
U.S.C. 1397bb(b)(1)(B)) is amended—
(i) in clause (i), by striking ‘‘, and’’ at 
the end and inserting a semicolon; 
(ii) in clause (ii), by striking the pe-
riod and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iii) at State option, may choose not 
to apply a waiting period in the case of a 
child 
described 
in 
section 
2105(a)(1)(C)(ii), if the State satisfies the 
requirements of section 2105(c)(8) and 
provides such child with child health assist-
ance that consists only of coverage of den-
tal services.’’. 
(E) OPTIONAL
APPLICATION
TO
ADULTS 
COVERED UNDER WAIVERS.—The amendments 
made by this paragraph shall also apply under 
title XXI of the Social Security Act at a State’s
option to adults receiving assistance under such 
title in a manner comparable to the manner in 
which such amendments apply to child health 
assistance furnished to a child covered under 
such title. 
(2) APPLICATION OF ENHANCED MATCH UNDER 
MEDICAID.—Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended—
(A) in subsection (b), in the fourth sen-
tence, by striking ‘‘or subsection (u)(3)’’ and 
inserting ‘‘(u)(3), or (u)(4)’’; and 
(B) in subsection (u)—
(i) by redesignating paragraph (4) as 
paragraph (5); and 
(ii) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) For purposes of subsection (b), the expenditures 
described in this paragraph are expenditures for dental 
services 
for 
children 
described 
in 
section 
2105(a)(1)(C)(ii), but only in the case of a State that sat-
isfies the requirements of section 2105(c)(8).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) take effect on the date of the enactment 
of this Act, and apply to child health assistance and med-
ical assistance provided on or after that date.
SEC. 5. ENHANCED MATCHING RATE UNDER MEDICAID 
FOR COVERAGE OF FULL ADULT DENTAL 
BENEFITS. 
(a) IN GENERAL.—Section 1905(b)(4) of the Social 
Security Act (42 U.S.C. 1396d(b)(4)) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘with respect to’’; 
and 
(2) by inserting before the period at the end the 
following: ‘‘and (B) with respect to medical assist-
ance provided for dental benefits for adults but only 
if such benefits cover the full range of dental bene-
fits (including orthodontia and dentures)’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to medical assistance for items 
and services furnished on or after the date of the enact-
ment of this Act, regardless of whether the State medicaid 
plan provided for full adult dental benefits before such 
date. 
SEC. 6. ESTABLISHMENT OF FUND FOR ORAL HEALTH 
SERVICES 
THROUGH 
COMMUNITY-BASED 
HEALTH CENTERS. 
(a) IN GENERAL.—There is established in the Treas-
ury of the United States a fund to be known as Commu-
nity Oral Health Expansion Fund (referred to in this sec-
tion as the ‘‘Fund’’). The Fund shall consist of such 
amounts as may be appropriated under subsection (b) to
the Fund. Amounts appropriated for the Fund shall re-
main available until expended. 
(b) 
AUTHORIZATION
OF
APPROPRIATIONS
TO 
FUND.—For each fiscal year beginning with fiscal year 
2006, there is authorized to be appropriated to the Fund 
$140,000,000. 
(c) USE OF FUND.—
(1) IN GENERAL.—Amounts in the Fund and 
available pursuant to appropriations Act shall be 
used by the Secretary of Health and Human Serv-
ices to make grants to the States for the purpose of 
establishing or expanding the availability of oral 
health services through Federally-qualified health 
centers (as defined in section 1905(l)(2)(B) of the 
Social Security Act), through school-based provision 
of health services, or through other nonprofit private 
or public community-based providers of health serv-
ices. 
(2) CERTAIN USES.—The purposes for which a 
grant under paragraph (1) may be expended include, 
with respect to oral health services—
(A) recruiting and compensating staff; 
(B) purchasing equipment; and 
(C) constructing, modernizing, or ren-
ovating facilities.
(3) USE FOR DEMONSTRATION PROJECTS.—In 
conjunction with any of the uses specified under 
paragraph (2), grants under paragraph (1) also may 
be used by health centers and other community-
based providers described in paragraph (1) for dem-
onstration projects and demonstration partnerships 
with Head Start programs for identifying children at 
risk of dental disease and providing early interven-
tion and prevention of such disease. 
(d) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—With respect to the costs of 
the program to be carried out under subsection (c) 
by a State, a grant under such subsection may be 
made only if the State agrees to make available (di-
rectly or through donations from public or private 
entities) non-Federal contributions toward such 
costs in an amount that is not less than 10 percent 
of such costs ($1 for each $9 of Federal funds pro-
vided in the grant). 
(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or services. 
Amounts provided by the Federal Government, or 
services assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions. 
(e) PRIORITY
FOR STATES COVERING MEDICAID 
LEVEL
OF DENTAL BENEFITS UNDER SCHIP AND 
PREFERENCE FOR STATES WITH MARKET-BASED PAY-
MENT RATES FOR DENTAL SERVICES UNDER MEDICAID 
AND SCHIP.—In awarding grants to States under this 
section, the Secretary of Health and Human Services 
shall—
(1) give priority to those States that provide, 
under its State child health insurance plan under 
title XXI of the Social Security Act, for the coverage 
of dental benefits in an amount, duration, and scope 
equivalent to that provided under its State medicaid 
plan under title XIX of such Act; and 
(2) give preference to States that provide for 
reimbursement under its State medicaid plan and its 
State child health insurance plan under titles XIX 
and XXI of such Act for dental services at levels 
consistent with market-based rates. 
(f) STATE DEFINED.—For purposes of this section, 
the term ‘‘State’’ has the meaning given such term for 
purposes of title XIX of the Social Security Act.
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