I 
118TH CONGRESS 
1ST SESSION H. R. 1342 
To amend title XIX of the Social Security Act to improve coverage of 
dental and oral health services for adults under Medicaid, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 3, 2023 
Ms. BARRAGA´N (for herself, Mr. DOGGETT, and Mr. GRIJALVA) 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 dental and oral health services for adults 
under Medicaid, 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 of 2023’’. 
SEC. 2. REQUIRING MEDICAID COVERAGE OF DENTAL AND 
ORAL HEALTH SERVICES FOR ADULTS. 
(a) IN GENERAL.— 
(1) MANDATORY COVERAGE.— 
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(A) IN GENERAL.— 
(i) 
REQUIREMENT.—Section 
1902(a)(10)(A) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)), as amended 
by section 11405(a)(1)(A) of Public Law 
117–169, is amended by inserting ‘‘(10),’’ 
before ‘‘(13)(B),’’. 
(ii) MEDICALLY NEEDY.— 
(I) 
IN
GENERAL.—Section 
1902(a)(10)(C)(iv) of such Act (42 
U.S.C. 
1396a(a)(10)(C)(iv)), 
as 
amended by section 11405(a)(1)(B) of 
Public Law 117–169, is amended by 
inserting ‘‘(10),’’ before ‘‘(13)(B)’’. 
(II) RULE OF CONSTRUCTION.— 
Nothing in this section or the amend-
ments made by this section shall be 
construed to limit the access of an in-
dividual residing in an institutional 
setting to dental and oral health serv-
ices (as such term is defined in sec-
tion 1905(jj) of the Social Security 
Act, as added by paragraph (2)(B)). 
(iii) EFFECTIVE DATE.—The amend-
ments made by clauses (i) and (ii) shall 
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apply with respect to expenditures for med-
ical assistance in calendar quarters begin-
ning on or after January 1, 2025. 
(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 Jan-
uary 1, 2025, coverage of dental and oral 
health services (as such term is defined in sec-
tion 1905(jj)).’’. 
(C) OPTIONAL
APPLICATION
TO
TERRI-
TORIES.—Section 1902(j) of the Social Security 
Act (42 U.S.C. 1396a(j)) is amended— 
(i) by striking ‘‘this title, the Sec-
retary’’ and inserting ‘‘this title— 
‘‘(1) in the case of a State other than the 50 
States and the District of Columbia the requirement 
under subsection (a)(10)(A) to provide the care and 
services listed in paragraph (10) of section 1905(a) 
shall be optional; and 
‘‘(2) the Secretary’’; and 
(ii) by striking the second comma 
after ‘‘section 1108(f)’’. 
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(2) DEFINITION OF DENTAL AND ORAL HEALTH 
SERVICES.—Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended— 
(A) in subsection (a)(10), by inserting 
‘‘and dental and oral health services (as defined 
in subsection (jj))’’ after ‘‘dental services’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(jj) DENTAL AND ORAL HEALTH SERVICES.—For 
purposes of subsection (a)(10), the term ‘dental and oral 
health services’ means dentures and denture services, im-
plants and implant services, and services necessary to pre-
vent oral disease and promote oral health, restore oral 
structures to health and function, reduce oral pain, and 
treat emergency oral conditions, that are furnished by a 
provider who is legally authorized to furnish such items 
and services under State law (or the State regulatory 
mechanism provided by State law).’’. 
(3) CONFORMING AMENDMENT.— 
(A) IN GENERAL.—Section 1905(a)(10) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(a)(10)), as amended by paragraph (2), is 
amended by striking ‘‘dental services and’’. 
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(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall take effect on 
January 1, 2025. 
(b) STATE OPTION FOR ADDITIONAL DENTAL AND 
ORAL HEALTH BENEFITS.—Section 1905(a)(13) of the 
Social Security Act (42 U.S.C. 1396d(a)(13)) is amended 
by inserting the following new subparagraph after sub-
paragraph (C): 
‘‘(D) at State option, such items and serv-
ices related to dental and oral health services 
(as defined in subsection (jj)) that are in addi-
tion to those identified in such subsection (jj) 
as the State may specify;’’. 
(c) INCREASED FMAP.— 
(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)’’; 
(B) in subsection (ff), by striking ‘‘and 
(ii)’’ and inserting ‘‘, (ii), and (kk)’’; and 
(C) by adding at the end the following new 
subsection: 
‘‘(kk) INCREASED FMAP FOR EXPENDITURES RE-
LATED TO DENTAL AND ORAL HEALTH SERVICES.— 
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‘‘(1) IN GENERAL.— 
‘‘(A) 
STATES
AND
DC.—Notwith-
standing subsection (b), in the case of a State 
that is 1 of the 50 States or the District of Co-
lumbia, during the 12-quarter period that be-
gins on January 1, 2025, the Federal medical 
assistance percentage shall be equal to 100 per-
cent with respect to amounts expended by the 
State for medical assistance for dental and oral 
health services authorized under paragraph (10) 
of subsection (a). In no case may the applica-
tion of this subparagraph result in the Federal 
medical assistance percentage determined for a 
State with respect to expenditures described in 
this subparagraph exceeding 100 percent. 
‘‘(B) TERRITORIES.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
subsection (b), in the case of a State that 
is Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, or Amer-
ican Samoa, during a period described in 
clause (ii), the Federal medical assistance 
percentage shall be equal to 100 percent 
with respect to amounts expended by the 
State for medical assistance for any item 
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or service that is included in dental and 
oral health services authorized under para-
graph (10) of subsection (a). In no case 
may the application of this clause result in 
the Federal medical assistance percentage 
determined for a State with respect to ex-
penditures described in this clause exceed-
ing 100 percent. 
‘‘(ii) PERIOD
DESCRIBED.—A period 
described in this clause is, with respect to 
an item or service described in clause (i) 
and a State described in such clause, the 
12-quarter period that begins with the first 
quarter beginning on or after January 1, 
2025, in which such item or service is first 
covered under the State plan or under a 
waiver of such plan. 
‘‘(2) EXCLUSIONS.—The Federal medical as-
sistance percentage specified in paragraph (1) shall 
not apply to amounts expended for medical assist-
ance during any period for— 
‘‘(A) additional items and services author-
ized under paragraph (13)(D) of subsection (a); 
or 
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‘‘(B) items and services furnished to an in-
dividual if, as of the date of enactment of this 
subsection, medical assistance was available to 
such individual for such items and services or 
medicare cost-sharing under the State plan or 
a waiver of such plan.’’. 
(2) EXCLUSION
OF
AMOUNTS
ATTRIBUTABLE 
TO INCREASED FMAP FROM TERRITORIAL CAPS.— 
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 (j)’’; and 
(B) by adding at the end the following: 
‘‘(j) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN-
TAL
AND ORAL HEALTH SERVICES.—Any additional 
amount paid to Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, and American Samoa for 
expenditures for medical assistance that is attributable to 
an increase in 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).’’. 
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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: 
‘‘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 
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‘‘(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. 
‘‘(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 
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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. 
‘‘(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; 
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‘‘(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 
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— 
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(A) in paragraph (86), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (87)(D), by striking the 
period and inserting ‘‘; and’’; and 
(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; 
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(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 
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.); 
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(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: 
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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