Foster Youth Dental Act of 2021
Bill: H.R.1794 | Sponsor: Rep. Bass, Karen (D-CA)
Policy area: Health

Summary:
Foster Youth Dental Act of 2021
This bill expands Medicaid coverage of current and former foster youth, particularly with respect to dental services.
Specifically, the bill requires state Medicaid programs to cover early and periodic screening, diagnostic, and treatment services, including dental services, for current and former foster youth under the age of 26. States must set a special payment rate, based on rates in the private sector, for dental services provided to such individuals; the bill provides an enhanced Federal Medical Assistance Percentage (i.e., federal matching rate) for excess expenses that result from such payments. The bill's requirements take effect 80 days after the date of enactment of the bill.
The bill also accelerates the application of certain provisions that require a state Medicaid program to cover former foster youth from other states until the age of 26; such provisions currently apply to former foster youth who reach the age of 18 on or after January 1, 2023. The bill instead applies these provisions to former foster youth who reach the age of 18 on or after the date of enactment of the bill.

To amend title XIX of the Social Security Act to strengthen coverage 
    under the Medicaid program for certain foster youth individuals.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Foster Youth Dental Act of 2021''.

SEC. 2. STRENGTHENING COVERAGE UNDER THE MEDICAID PROGRAM FOR CERTAIN 
              FOSTER YOUTH INDIVIDUALS.

    (a) Expansion of EPSDT Services to Certain Individuals Aged 21-
25.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (4)(B), by inserting ``(or, in the 
                case of a specified individual (as defined in the 
                matter at the end of this subsection), under the age of 
                26)'' after ``21''; and
                    (B) by adding at the end the following new 
                sentence: ``For purposes of paragraph (4)(B), the term 
                `specified individual' means an individual who is in 
                foster care under the responsibility of a State (or was 
                in foster care under the responsibility of the State on 
                the date of attaining 18 years of age or such higher 
                age as the State has elected under section 
                475(8)(B)(iii) and was enrolled in a State plan under 
                this title or under a waiver of a plan while in such 
                foster care).''.
            (2) Provision of information with respect to dental 
        services.--Section 1902(a)(43)(A) of the Social Security Act 
        (42 U.S.C. 1396a(a)(43)(A)) is amended--
                    (A) by inserting ``(or, in the case of a specified 
                individual (as defined in the matter at the end of 
                section 1905(a)), under the age of 26)'' after ``21'';
                    (B) by inserting ``(including dental services)'' 
                after ``treatment services'';
                    (C) by striking ``and the need'' and inserting ``, 
                the need''; and
                    (D) by striking the comma at the end and inserting 
                ``, and the importance of maintaining good oral 
                health,''.
            (3) Effective date.--
                    (A) Extension of coverage.--The amendments made by 
                paragraph (1) shall apply with respect to medical 
                assistance furnished during calendar quarters beginning 
                on or after the date that is 80 days after the date of 
                the enactment of this Act.
                    (B) Provision of information.--The amendment made 
                by paragraph (2) shall apply to information provided 
                under section 1902(a)(43)(A) of the Social Security Act 
                (42 U.S.C. 1396a(a)(43)(A)) beginning with the first 
                calendar quarter beginning on or after the date that is 
                80 days after the date of the enactment of this Act.
    (b) Incentive for the Provision of Dental Services to Certain 
Individuals.--
            (1) In general.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a(a)) is amended--
                    (A) in paragraph (13)--
                            (i) in subparagraph (B), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (C), by adding ``and'' 
                        at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(D) for payment for dental services furnished on 
                or after the first day of the first calendar quarter 
                beginning on or after the date that is 80 days after 
                the date of the enactment of this subparagraph by a 
                dentist to a specified individual (as defined in the 
                matter at the end of section 1905(a)) under the age of 
                26 at a rate not less than the specified average rate 
                (as defined in subsection (tt)) for such services.''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(tt) Specified Average Rate Defined.--
            ``(1) In general.--For purposes of subsection (a)(13)(D), 
        the term `specified average rate' means, with respect to a 
        dental service furnished in a State, the average of the 
        contracted rates (as defined in paragraph (2)) in effect during 
        the 5-year period ending on the date such service is so 
        furnished--
                    ``(A) for such service furnished in such State (as 
                determined by the State); or
                    ``(B) for such service furnished in the United 
                States (as determined by the Secretary);
        as selected by such State.
            ``(2) Contracted rate defined.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the term `contracted rate' means, with respect to a 
                dental service, a rate in effect between a health 
                insurance issuer offering group or individual health 
                insurance coverage or a group health plan (as such 
                terms are defined in section 2791 of the Public Health 
                Service Act) and a dentist with a contractual 
                relationship in effect with such issuer or plan (as 
                applicable) for furnishing such service under such 
                coverage or plan (as applicable) that represents the 
                total amount payable (including cost sharing) under 
                such coverage or plan (as applicable) for such service 
                so furnished.
                    ``(B) Exclusion of self-insured group health plan 
                rates.--For purposes of subparagraph (A), the term 
                `contracted rate' shall not include a rate described in 
                such subparagraph that is in effect between a self-
                insured group health plan and a dentist.''.
            (2) Medicaid managed care plans.--Section 1932(f) of the 
        Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
                    (A) in the header, by striking ``Primary Care 
                Services'' and inserting ``Certain Services'';
                    (B) by inserting ``or dental services'' after 
                ``primary care services'';
                    (C) by striking ``section 1902(a)(13)(C)'' and 
                inserting ``subparagraph (C) or (D), respectively, of 
                section 1902(a)(13)''; and
                    (D) by striking ``such section'' and inserting 
                ``such subparagraph (C) or (D), as applicable''.
            (3) Increased fmap for increased expenses.--Section 1905 of 
        the Social Security Act (42 U.S.C. 1396d) is amended by adding 
        at the end the following new subsection:
    ``(gg) Increased FMAP for Additional Expenditures for Dental 
Services.--Notwithstanding subsection (b), with respect to the portion 
of the amounts expended for medical assistance for services described 
in section 1902(a)(13)(D) furnished on or after the first day of the 
first calendar quarter beginning on or after the date that is 80 days 
after the date of the enactment of this subsection furnished to an 
individual described in such section by a dentist that is attributable 
to the amount by which the minimum payment rate required under such 
section (or, by application, section 1932(f)) exceeds the payment rate 
applicable to such services under the State plan as of January 1, 2021, 
the Federal medical assistance percentage for a State that is one of 
the 50 States or the District of Columbia shall be equal to 100 
percent. The preceding sentence does not prohibit the payment of 
Federal financial participation based on the Federal medical assistance 
percentage for amounts in excess of those specified in such 
sentence.''.
    (c) Outreach Efforts for Enrollment of Former Foster Children.--
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is 
amended--
            (1) in paragraph (85), by striking ``; and'' and inserting 
        a semicolon;
            (2) in paragraph (86), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (86) the following new 
        paragraph:
            ``(87) not later than 6 months after the date of the 
        enactment of this paragraph--
                    ``(A) establish an outreach and enrollment program, 
                in coordination with the State agency responsible for 
                administering the State plan under part E of title IV 
                and any other appropriate or interested agencies, 
                designed to increase the enrollment of individuals who 
                are eligible for medical assistance under the State 
                plan under paragraph (10)(A)(i)(IX) in accordance with 
                best practices established by the Secretary; and
                    ``(B) establish an outreach program to dentists 
                practicing in such State to encourage enrollment by 
                such dentists in such plan as participating providers 
                under such plan.''.
    (d) Providing for Immediate Eligibility for Former Foster Youth.--
Section 1002(a)(2) of the SUPPORT for Patients and Communities Act 
(Public Law 115-271) is amended by striking ``January 1, 2023'' and 
inserting ``the date of enactment of the Foster Youth Dental Act of 
2021''.
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