I
107TH CONGRESS
2D SESSION
H. R. 5191
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
JULY 23, 2002
Mr. SANDERS (for himself, Ms. LEE, Mr. HINCHEY, Mr. LARSON of Con-
necticut, and Mr. FRANK) introduced the following bill; which was re-
ferred 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 2002’’.
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, 2003.
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, 2002;
‘‘(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;
(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.