I 
111TH CONGRESS 
2D SESSION 
H. R. 5364 
To amend title XIX of the Social Security Act to require States to provide 
oral health services to aged, blind, or disabled individuals under the 
Medicaid Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 20, 2010 
Mr. STUPAK 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 require 
States to provide oral health services to aged, blind, 
or disabled individuals 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; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Special Care Dentistry Act of 2010’’. 
(b) FINDINGS.—Congress finds the following: 
(1) According to the United States Surgeon 
General’s Report on Oral Health in America: 
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(A) No less than a silent epidemic of oral 
diseases is affecting our most vulnerable citi-
zens, including low income elderly, individuals 
with disabilities, and many members of racial 
and ethnic minority groups. 
(B) Oral diseases and conditions affect 
health and well-being throughout life. The bur-
den of oral problems is extensive and may be 
particularly severe in vulnerable populations. 
(C) Oral diseases and conditions are asso-
ciated with other health problems. Associations 
between chronic oral infections and other health 
problems, including diabetes, heart disease, and 
adverse pregnancy outcomes have been re-
ported. 
(2) Providing appropriate and necessary oral 
health benefits under Medicaid to individuals classi-
fied as aged, blind, or disabled would prevent unnec-
essary emergency room visits, hospitalizations, and 
downstream health care costs, reducing Medicaid 
spending. 
(3) While 28 percent of the people enrolled in 
Medicaid are aged, blind, or disabled, the high cost 
of medical expenditures for these populations con-
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sumes 72 percent of the total Medicaid budget. This 
is not the case with dental benefits. 
(4) For the aged, blind, or disabled, oral health 
services are deemed ‘‘optional’’ by the Federal Gov-
ernment and most States provide little to no Med-
icaid coverage for these services. Many of these vul-
nerable citizen’s mouths are infected with no hope of 
receiving access to even basic dental care. 
(5) In 2003, adult aged, blind, and disabled 
Medicaid recipients received basic oral health serv-
ices in only 6 States (Connecticut, New Jersey, New 
York, North Dakota, Pennsylvania, and Wisconsin). 
(6) Appropriate and necessary oral health serv-
ices for adult aged, blind, and disabled people will 
help reduce not only Medicaid costs for these popu-
lations, but also down-stream Medicare expenditures, 
which together total almost $600,000,000,000 annu-
ally. 
(7) Dental office overhead averages over 65 
percent. Unfortunately, Medicaid reimbursement 
rates fall far short of covering these expenses. 
(8) Additional Federal investment for the deliv-
ery of oral health services is needed to ensure vul-
nerable adults receive oral health benefits. 
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(9) Investments are needed for an oral health 
initiative to reduce the profound disparities in oral 
health by improving the health status of vulnerable 
populations to the level of health status that is en-
joyed by the majority of Americans. 
SEC. 2. REQUIREMENT TO PROVIDE AGED, BLIND, OR DIS-
ABLED INDIVIDUALS WITH ORAL HEALTH 
SERVICES UNDER THE MEDICAID PROGRAM. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.), as amended by the Patient 
Protection and Affordable Care Act (Public Law 111– 
148), is amended by inserting after section 1943 the fol-
lowing new section: 
‘‘ORAL HEALTH SERVICES FOR AGED, BLIND, OR 
DISABLED INDIVIDUALS 
‘‘SEC. 1944. (a) SERVICES UNDER A STATE ADULT 
DENTAL PROGRAM FOR AGED, BLIND, OR DISABLED IN-
DIVIDUALS.—A State shall provide oral health coverage 
for aged, blind, or disabled individuals described in sub-
section (b) through a separate State adult dental program. 
The State shall demonstrate that the services and fees 
provided and program requirements under this section are 
at least equivalent to the services, fees, and requirements 
that are provided to children under this title and include 
age-appropriate services for such individuals, and that the 
services are provided at intervals to determine the exist-
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