I 
112TH CONGRESS 
1ST SESSION H. R. 1606 
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 
APRIL 15, 2011 
Mr. ENGEL (for himself and Ms. SCHAKOWSKY) 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 2011’’. 
(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 downstream 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.) is amended by inserting after 
section 1943 the following 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-
ence of a suspected illness or condition consistent with rea-
sonable standards of dental practice (taking into account 
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the increased needs and oral health complexities of the 
population) as determined by the Secretary after consulta-
tion with national professional dental organizations. 
‘‘(b) AGED, BLIND, OR DISABLED INDIVIDUALS DE-
SCRIBED.—For purposes of subsection (a), an aged, blind, 
or disabled individual described in this subsection is an 
individual— 
‘‘(1) who is eligible for medical assistance under 
subclause (I) or (II) of section 1902(a)(10)(A)(i) 
(but only, in the case of subclause (I), with respect 
to an individual who is so eligible on the basis of re-
ceiving aid or assistance under any plan of the State 
approved under title I, X, XIV, or XVI); and 
‘‘(2) who would be considered an aged, blind, or 
disabled individual under section 1614 (without re-
gard to whether the individual satisfies the income 
and resource requirements for receiving supple-
mental security income benefits under title XVI) and 
is otherwise eligible for medical assistance under the 
State plan or under a waiver of such plan. 
‘‘(c) TRANSPORTATION.—The State shall provide 
transportation for aged, blind, or disabled individuals de-
scribed in subsection (b) to dental offices, hospitals, clin-
ics, or other treatment centers for the provision of oral 
health services to the same extent that transportation is 
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provided under the State plan for children eligible for 
medical assistance.’’. 
(b) DEFINITION OF ORAL HEALTH SERVICES.— 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a), by amending para-
graph (10) to read as follows: 
‘‘(10) oral health services (as defined in sub-
section (ee)); and’’; and 
(B) by adding at the end the following: 
‘‘(ee)(1) For purposes of this title, the term ‘oral 
health services’ means— 
‘‘(A) relief of pain and infections; 
‘‘(B) restoration or replacement of teeth; 
‘‘(C) periodontal treatment; 
‘‘(D) dental health preventive services, including 
adult fluoride application; 
‘‘(E) in-patient and out-patient dental surgical, 
evaluation, and examination services; 
‘‘(F) dentures or partial denture care; 
‘‘(G) per patient house call and long term care 
facility visits; 
‘‘(H) sedation and anesthesia; and 
‘‘(I) behavior management services. 
‘‘(2) For the purpose of this subsection: 
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‘‘(A) The term ‘long term care facility’ means— 
‘‘(i) a nursing facility; 
‘‘(ii) an assisted living facility or a resident 
care program facility (as such terms are defined 
by the Secretary); 
‘‘(iii) a board and care facility (as defined 
in section 1903(q)(4)(B), including a mental re-
tardation group home); 
‘‘(iv) an intermediate care facility for the 
mentally retarded; and 
‘‘(v) any other facility that is licensed or 
certified by the State and is determined appro-
priate by the Secretary, such as a community 
mental health center that meets the require-
ments of section 1913(c) of the Public Health 
Service Act, a psychiatric health facility, and a 
mental health rehabilitation center. 
‘‘(B) The term ‘house call’ means the delivery 
of dental services in long term care facilities needed 
to overcome mobility impairments and transpor-
tation barriers. 
‘‘(C) The term ‘behavior management’ means 
services needed to accommodate physical or behav-
ioral impairment.’’. 
(c) CONFORMING AMENDMENTS.— 
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(1) 
TERMINOLOGY.—Section 
1902(a)(43)(D)(iii) of the Social Security Act (42 
U.S.C. 1396a(a)(43)(D)(iii)) is amended by striking 
‘‘dental’’ and inserting ‘‘oral health’’ each place it 
appears. 
(2) STATE PLAN.—Section 1902(a) of such Act 
(42 U.S.C. 1396a(a)) is amended— 
(A) in paragraph (82), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (83), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (83) the 
following: 
‘‘(84) provide for— 
‘‘(A) making oral health services available 
to aged, blind, or disabled individuals described 
in subsection (b) of section 1944 in accordance 
with the requirements of that section; 
‘‘(B) informing all persons in the State 
who are aged, blind, or disabled and have been 
determined to be eligible for medical assistance 
including oral health services (as defined in sec-
tion 1905(ee)), of the availability of such serv-
ices; 
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‘‘(C) providing or arranging for the provi-
sion of such services in all cases where they are 
requested; 
‘‘(D) arranging for (directly or through re-
ferral to appropriate agencies, organizations, or 
individuals) corrective treatment the need for 
which is disclosed by such services; and 
‘‘(E) reporting to the Secretary (in a uni-
form form and manner established by the Sec-
retary, by aged, blind, or disabled group and by 
basis of eligibility for medical assistance, and by 
not later than April 1 after the end of each fis-
cal year, beginning with fiscal year 2012) the 
information relating to oral health services pro-
vided under the plan during each fiscal year 
consisting of— 
‘‘(i) the number of aged, blind, or dis-
abled individuals who reside in the State; 
‘‘(ii) the number of aged, blind, or 
disabled individuals provided oral health 
services; 
‘‘(iii) the number of such individuals 
referred for corrective treatment (the need 
for which is disclosed by such services); 
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‘‘(iv) the amount of, and type of, pre-
ventive oral health services needed and 
provided; 
‘‘(v) the amount of, and type of, sur-
gical restorative oral health services needed 
and provided; and 
‘‘(vi) the amount of, and type of, 
other oral health services needed and pro-
vided, disaggregated into whether the serv-
ices were— 
‘‘(I) emergency; 
‘‘(II) preventive; 
‘‘(III) surgical; 
‘‘(IV) restorative; 
‘‘(V) periodontal; 
‘‘(VI) endodontic; or 
‘‘(VII) prosthodontic.’’. 
(3) 
NURSING
FACILITIES.—Section 
1919(b)(4)(A)(vi) 
of 
such 
Act 
(42 
U.S.C. 
1396r(b)(4)(A)(vi)) is amended by inserting, ‘‘oral 
health services (as defined in section 1905(ee)) for 
an aged, blind, or disabled individual described in 
section 1944(b) who is a resident of the nursing fa-
cility,’’ after ‘‘plan)’’. 
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(d) FEDERAL FUNDING FOR COST OF COVERING 
AGED, BLIND, OR DISABLED.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d), as amended by sub-
section (b)(1), is amended— 
(1) in subsection (b), in the first sentence, by 
inserting ‘‘subsection (ee) and’’ before ‘‘section 
1933(d)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ff) INCREASED FMAP FOR MEDICAL ASSISTANCE 
FOR AGED, BLIND, AND DISABLED INDIVIDUALS.—The 
Federal medical assistance percentage determined for a 
State that is one of the 50 States or the District of Colum-
bia for each fiscal year with respect to amounts expended 
for medical assistance for aged, blind and disabled individ-
uals described in section 1944(b) shall be equal to 100 
percent.’’. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to calendar quarters beginning on or 
after October 1, 2011, without regard to whether or 
not final regulations to carry out such amendments 
have been promulgated by such date. 
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(2) DELAY
PERMITTED
FOR
STATE
PLAN 
AMENDMENT.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act which the Secretary of Health and Human Serv-
ices determines requires State legislation (other than 
legislation appropriating funds) in order for the plan 
to meet the additional requirements imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet these additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of enact-
ment of this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2-year legis-
lative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
Æ 
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