I 
117TH CONGRESS 
1ST SESSION H. R. 4439 
To amend title XIX of the Social Security Act to improve coverage of 
adult oral health care under the Medicaid program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 16, 2021 
Ms. BARRAGA´N (for herself, Mr. GRIJALVA, Ms. VELA´ZQUEZ, Mr. PAYNE, Mr. 
SOTO, and Ms. NORTON) 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 adult oral health care under the Medicaid 
program, and for other purposes. 
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 ‘‘Medicaid Dental Ben-
efit Act’’. 
SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES 
FOR ADULTS UNDER THE MEDICAID PRO-
GRAM. 
(a) IN GENERAL.— 
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(1) MANDATORY COVERAGE.— 
(A) IN GENERAL.— 
(i) 
REQUIREMENT.—Section 
1902(a)(10)(A) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)) is amended 
by inserting ‘‘(10),’’ after ‘‘(5),’’. 
(ii) EFFECTIVE
DATE.—The amend-
ment made by clause (i) shall apply with 
respect to medical assistance furnished in 
calendar quarters beginning on or after the 
date that is 1 year after the date of the en-
actment of this Act. 
(B) 
BENCHMARK
COVERAGE.—Section 
1937(b)(5) of the Social Security Act (42 
U.S.C. 1396u–7(b)(5)) is amended by striking 
the period and inserting ‘‘, and, beginning with 
the first quarter beginning on or after the date 
that is 1 year after the date of the enactment 
of the Medicaid Dental Benefit Act, coverage of 
dental and oral health services (as defined in 
section 1905(jj)).’’. 
(2) DEFINITION OF SERVICES.—Section 1905 
of the Social Security Act (42 U.S.C. 1396d) is 
amended— 
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(A) in subsection (a)(10), by striking ‘‘den-
tal services’’ and inserting ‘‘dental and oral 
health services (as defined in subsection (jj))’’; 
and 
(B) by adding at the end the following new 
subsection: 
‘‘(jj) DEFINITION OF DENTAL AND ORAL HEALTH 
SERVICES.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘dental and oral health services’ means 
services necessary to prevent disease and promote 
oral health, restore oral structures to health and 
function, reduce oral pain, and treat emergency oral 
conditions. Such term includes the services specified 
in paragraph (2). 
‘‘(2) SPECIFIED
SERVICES.—For purposes of 
paragraph (1), the services specified in this para-
graph are the following: 
‘‘(A) Routine diagnostic and preventive 
care (such as dental cleanings, exams, and x- 
rays). 
‘‘(B) Basic dental services (such as fillings 
and extractions) and major dental services 
(such as root canals, crowns, and dentures). 
‘‘(C) Emergency dental care. 
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‘‘(D) 
Temporomandibular 
(TMD) 
and 
orofacial pain disorder treatment. 
‘‘(E) Other necessary services related to 
dental and oral health (as specified by the Sec-
retary).’’. 
(b) ENHANCED
FMAP; MAINTENANCE
OF
EF-
FORT.— 
(1) MEDICAID.—Section 1905 of the Social Se-
curity Act (42 U.S.C. 1396d), as amended by sub-
section (a), is further amended— 
(A) in subsection (b), by striking ‘‘and 
(ii)’’ and inserting ‘‘(ii), and (kk)’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(kk) INCREASED FMAP FOR EXPENDITURES FOR 
DENTAL AND ORAL HEALTH SERVICES.— 
‘‘(1) IN GENERAL.—The Federal medical assist-
ance percentage with respect to amounts expended 
by such State for medical assistance consisting of 
dental and oral health services (as defined in sub-
section (jj)) furnished during the first calendar 
quarter beginning on or after the date that is 1 year 
after the date of the enactment of this subsection (or 
during any subsequent quarter) to individuals 21 
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years of age or older shall be equal to, in the case 
of such services furnished— 
‘‘(A) during the 3-year period beginning on 
the first day of such first calendar quarter, 100 
percent; 
‘‘(B) during the 1-year period immediately 
following the period described in subparagraph 
(A), 95 percent; 
‘‘(C) during each subsequent 1-year period 
(through the third such subsequent period), the 
percentage specified under this paragraph for 
the preceding 1-year period, reduced by 5 per-
centage points; and 
‘‘(D) during any quarter beginning after 
the 7-year period beginning on the first day de-
scribed in subparagraph (A), 80 percent. 
‘‘(2) NO REDUCTION IN FMAP.—Paragraph (1) 
shall not apply with respect to amounts expended by 
a State if the Federal medical assistance percentage 
otherwise applicable to such amounts without appli-
cation of such paragraph would be higher than such 
percentage applicable to such amounts with applica-
tion of such paragraph.’’. 
(2) EXCLUSION
OF
AMOUNTS
ATTRIBUTABLE 
TO INCREASED FMAP FROM TERRITORIAL CAPS.— 
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Section 1108 of the Social Security Act (42 U.S.C. 
1308) is amended— 
(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsections 
(g) and (h)’’ and inserting ‘‘subsections (g), 
(h), and (i)’’; and 
(B) by adding at the end the following: 
‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN-
TAL AND ORAL HEALTH SERVICES.—Any payment made 
to a territory for expenditures for medical assistance that 
are subject to an increase the Federal medical assistance 
percentage applicable to such expenditures under section 
1905(kk) shall not be taken into account for purposes of 
applying payment limits under subsections (f) and (g) to 
the extent that such payment exceeds the amount of the 
payment that would have been made to the territory for 
such expenditures without regard to such section.’’. 
SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEAS-
URES. 
(a) IN GENERAL.—Title XI of the Social Security Act 
(42 U.S.C. 1301 et seq.) is amended by inserting after 
section 1139B the following new section: 
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‘‘SEC. 1139C. ADULT ORAL HEALTH QUALITY AND EQUITY 
MEASURES. 
‘‘(a) DEVELOPMENT OF CORE SET OF ADULT ORAL 
HEALTH CARE QUALITY AND EQUITY MEASURES.— 
‘‘(1) IN GENERAL.—The Secretary shall iden-
tify and publish a recommended core set of health 
quality and equity measures for individuals enrolled 
in a State plan (or waiver of such plan) under title 
XIX who are over the age of 21 in the same manner 
as the Secretary identifies and publishes a core set 
of child health quality measures under section 
1139A, including with respect to identifying and 
publishing existing oral health quality measures for 
such individuals that are in use under public and 
privately sponsored health care coverage arrange-
ments, or that are part of reporting systems that 
measure both the presence and duration of health 
insurance coverage over time, that may be applicable 
to enrolled adults. 
‘‘(2) ALIGNMENT WITH EXISTING CORE SET.— 
In identifying and publishing the recommended core 
set of adult oral health quality and equity measures 
required under paragraph (1), the Secretary shall 
ensure that, to the extent possible, such measures 
align with and do not duplicate the core set of adult 
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health quality and equity measures identified, pub-
lished, and revised under section 1139B. 
‘‘(3) PROCESS FOR ADULT ORAL HEALTH QUAL-
ITY AND EQUITY MEASURES PROGRAM.—In identi-
fying gaps in existing adult oral health quality and 
equity measures and establishing priorities for the 
development and advancement of such measures, the 
Secretary shall consult with— 
‘‘(A) States; 
‘‘(B) health care providers; 
‘‘(C) patient representatives; 
‘‘(D) dental professionals; and 
‘‘(E) national organizations with expertise 
in oral health quality or equity measurement. 
‘‘(b) DEADLINES.— 
‘‘(1) RECOMMENDED
MEASURES.—Not later 
than 1 year after enactment of this Act, the Sec-
retary shall identify and publish for comment a rec-
ommended core set of adult oral health quality and 
equity measures that includes the following: 
‘‘(A) Measures of utilization of oral health 
and dental services across health care settings. 
‘‘(B) Measures that address the availability 
of oral evaluations during or following medical 
visits for enrolled adults. 
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application or sealants during the report-
ing year involved. 
‘‘(iii) The percentage of enrolled 
adults who received a comprehensive or 
periodic oral evaluation or a comprehensive 
periodontal evaluation during the reporting 
year involved. 
‘‘(iv) The percentage of enrolled 
adults with a history of periodontitis who 
received an oral prophylaxis, scaling or 
root planing, or periodontal maintenance 
visit at least 2 times during the reporting 
year involved. 
‘‘(v) The percentage of enrolled adults 
with diabetes who receive a comprehensive 
or periodic evaluation or a comprehensive 
periodontal evaluation during the reporting 
year involved. 
‘‘(vi) The percentage of enrolled 
adults who require tooth extraction during 
the reporting year involved. 
‘‘(vii) The percentage of enrolled 
adults who require partial or full dentures 
during the reporting year involved. 
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‘‘(2) DISSEMINATION.—Not later than 1 year 
after enactment of this Act, the Secretary shall pub-
lish an initial core set of oral health quality and eq-
uity measures that are applicable to enrolled adults. 
‘‘(3) STANDARDIZED
REPORTING.—Not later 
than 2 years after the date of the enactment of this 
Act, the Secretary, in consultation with States, shall 
develop a standardized format for the collection and 
reporting of information based on the initial core set 
of adult oral health quality and equity measures 
(stratified by race, ethnicity, primary language, dis-
ability status, sexual orientation and gender iden-
tity) and create guidelines, procedures, and incen-
tives to States to use such measures and to collect 
and report information regarding the quality and eq-
uity of oral health care for enrolled adults. 
‘‘(4) REPORTS TO CONGRESS.—Not later than 
3 years after enactment of this act, and every 3 
years thereafter, the Secretary shall include in the 
report 
to 
Congress 
required 
under 
section 
1139A(a)(6) information similar to the information 
required under that section with respect to the 
measures established under this section. 
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‘‘(c) ANNUAL STATE REPORTS REGARDING STATE- 
SPECIFIC ORAL HEALTH QUALITY AND EQUITY MEAS-
URES APPLIED UNDER MEDICAID.— 
‘‘(1) IN GENERAL.—Each State with a plan ap-
proved under title XIX (or with a waiver of such 
plan in effect) shall annually report (separately or as 
part of the annual report required under section 
1139A(c)) to the Secretary on— 
‘‘(A) the State-specific adult oral health 
quality and equity measures applied by the 
State under such a plan or waiver, including 
measures described in subsection (b)(1); 
‘‘(B) the State-specific information on the 
quality and equity of oral health care furnished 
to enrolled adults under such a plan or waiver, 
including information collected through external 
quality reviews of managed care organizations 
under section 1932 and benchmark plans under 
section 1937, disaggregated by race, ethnicity, 
primary language, disability status, sexual ori-
entation, and gender identity; 
‘‘(C) the State-specific information regard-
ing the dental benefits available to enrolled 
adults under such a plan or waiver, including 
any limits on such benefits and the amount of 
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reimbursement provided under such plan or 
waiver for such benefits; and 
‘‘(D) the State-specific plan to identify, 
evaluate, and reduce in meaningful and measur-
able ways, to the extent practicable, health dis-
parities based on age, sex, race, ethnicity, pri-
mary language, sexual orientation and gender 
identity, and disability status. 
‘‘(2) PUBLICATION.—Not later than 2 years 
after the date of enactment of this Act, and annually 
thereafter, the Secretary shall collect, analyze, and 
make publicly available the information reported by 
States under paragraph (1). 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $10,000,000 to carry 
out this section. Funds appropriated under this subsection 
shall remain available until expended.’’. 
(b) REQUIRED REPORTING.— 
(1) MEDICAID.—Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)) is amended— 
(A) in paragraph (86), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (87)(D), by striking the 
period and inserting ‘‘; and’’; and 
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(C) by inserting after paragraph (87) the 
following new paragraph: 
‘‘(88) provide for the reporting required under 
section 1139C(c).’’. 
(2) CHIP.—Section 2102 of the Social Security 
Act (42 U.S.C. 1397bb) is amended by adding at 
the end the following new subsection: 
‘‘(d) REPORTING REQUIREMENTS.—A State child 
health plan shall provide for the reporting required under 
section 1139C(c).’’. 
SEC. 4. ADULT ORAL HEALTH CARE REPORT. 
Not later than 2 years after the date of enactment 
of this Act, the Medicaid and CHIP Payment and Access 
Commission shall submit to Congress a report on issues 
related to adult oral health across the 50 States, tribes, 
and the territories, including— 
(1) the availability of adult oral health cov-
erage, and enrollment in such coverage; 
(2) a survey of adult oral health status among 
low-income women of childbearing age; 
(3) barriers to accessing adult oral health care, 
including for racially diverse, ethnically diverse, and 
limited English proficient communities; 
(4) innovations and potential solutions to prob-
lems of access (including disparities in access) to 
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adult oral health care, including innovations that 
would expand access to such care beyond dental of-
fices; and 
(5) the impact of the amendments made by sec-
tion 2 and recommendations for improving reim-
bursement rates for such provider of dental and oral 
health services under the Medicaid program. 
SEC. 5. ORAL HEALTH OUTREACH AND EDUCATION. 
Not later than 1 year after the date of enactment 
of this Act, the Secretary shall develop a program, to be 
implemented through contracts with entities that fund or 
provide oral health care, to provide— 
(1) culturally competent and linguistically ap-
propriate information on the availability and scope 
of oral health and dental coverage for adults who are 
eligible for or enrolled under a State plan (or waiver 
of such plan) under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.); 
(2) assistance in connecting adults and under-
served populations enrolled in such a plan (or waiv-
er) to oral health care; 
(3) education to dental, oral health, and med-
ical professionals to strengthen core competencies in 
delivering culturally competent oral health care to 
adults enrolled in such a plan (or waiver), including: 
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individuals with physical and intellectual disabilities, 
pregnant and postpartum individuals, Alaskan Na-
tive and American Indian populations, and people 
living in urban, rural and, other underserved com-
munities; and 
(4) culturally competent and linguistically ap-
propriate interactive oral health education aimed at 
promoting good oral health practices for adults, in-
cluding racially and ethnically diverse Medicaid 
beneficiaries. 
Æ 
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