Requiring Medicaid coverage of dental and oral health services for adults

(a) In general (1) Mandatory coverage (A) In general (i) Requirement Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) 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)) is amended by inserting (10), before (13)(B). (II) Rule of construction Nothing in this section or the amendments made by this section shall be construed to limit the access of an individual residing in an institutional setting to dental and oral health services (as such term is defined in section 1905(ll) of the Social Security Act, as added by paragraph (2)(B)). (iii) Effective date The amendments made by clauses (i) and (ii) shall apply with respect to expenditures for medical assistance in calendar quarters beginning on or after January 1, 2028. (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 January 1, 2028, coverage of dental and oral health services (as such term is defined in section 1905(ll)).. (C) Optional application to territories Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended— (i) by striking this title, the Secretary 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). (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 (ll)) after dental services; and (B) by adding at the end the following new subsection: (ll) Dental and oral health services For purposes of subsection (a)(10), the term dental and oral health services means dentures and denture services, implants and implant services, and services necessary to prevent 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. (B) Effective date The amendment made by subparagraph (A) shall take effect on January 1, 2028. (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— (1) in subparagraph (B), by striking; and and inserting a semicolon; (2) in subparagraph (C), by striking the semicolon at the end and inserting; and; and (3) by inserting after subparagraph (C) the following new subparagraph: (D) at State option, such items and services related to dental and oral health services (as defined in subsection (ll)) that are in addition to those identified in such subsection (ll) as the State may specify;. (c) Increased FMAP (1) Medicaid Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by subsections (a) and (b), is further amended— (A) in subsection (b), by striking and (ii) and inserting (ii), and (mm); (B) in subsection (ff), by striking and (ii) and inserting, (ii), and (mm); and (C) by adding at the end the following new subsection: (mm) Increased FMAP for expenditures related to dental and oral health services (1) In general (A) 50 States and DC Notwithstanding subsection (b), in the case of a State that is 1 of the 50 States or the District of Columbia, during the 12-quarter period that begins on January 1, 2028, the Federal medical assistance percentage shall be equal to 100 percent 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 application 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 American 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 or service that is included in dental and oral health services authorized under paragraph (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 expenditures described in this clause exceeding 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, 2028, 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 assistance percentage specified in paragraph (1) shall not apply to amounts expended for medical assistance during any period for— (A) additional items and services authorized under paragraph (13)(D) of subsection (a); or (B) items and services furnished to an individual 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 preceding 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 attributable to increased FMAP for coverage of dental 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(mm) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g)..