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.

February 2, 2005

Mr. SANDERS (for himself, Mr. KILDEE, Mr. MEEHAN, Ms. LEE, Ms. WOOLSEY, Mr. HINCHEY, Ms. SOLIS, Mr. OLVER, Mr. NADLER, Mr. CUMMINGS, Mr. LEWIS of Georgia, Mr. DEFAZIO, Mr. ABERCROMBIE, Mr. KUCINICH, Mr. DAVIS of Illinois, Ms. WATSON, Mr. GUTIERREZ, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce

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 Representatives 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 2005'.

SEC. 2. FINDINGS.

Congress finds the following:

(1) Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being, yet 108 million Americans have no public or private dental insurance.

(2) Although oral health in America has improved dramatically over the last 50 years, dental caries (cavities) are presently the single most common chronic childhood disease, five times more likely than asthma and seven times more common than hay fever.

(3) According to the Surgeon General, low-income, minority children experience significant disparities in oral health status and access to basic dental care. In a year-long study, the Surgeon General found that fewer than one in five Medicaid-covered children received a single dental visit during that period and that 25 percent of poor and minority children never visit a dentist before entering kindergarten.

(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 adding 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, 2006.

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 following:

`(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 requirements (other than income-related requirements) 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 subsection (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, 2005;

`(ii) subject to subparagraph (B), does not limit the acceptance of applications for children; and

`(iii) provides benefits to all children in the State who apply for and meet eligibility 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, waiting list, or similar limitation on the eligibility of such children for child health assistance under such State plan.'.

(C) AUTHORIZATION OF APPROPRIATIONS- In addition to any funds otherwise authorized to be appropriated, there are authorized 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 PERIOD- 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 and inserting a semicolon;

(ii) in clause (ii), by striking the period and inserting `; and'; and

(iii) by adding at the end the following 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 assistance that consists only of coverage of dental 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 sentence, 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 satisfies 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 medical assistance provided on or after that date.

SEC. 5. ENHANCED MATCHING RATE UNDER MEDICAID FOR COVERAGE OF FULL ADULT DENTAL BENEFITS.

(a) In General- Section 1905(b)(4) of the Social Security Act (42 U.S.C. 1396d(b)(4)) is amended--

(1) by inserting `(A)' after `with respect to'; and

(2) by inserting before the period at the end the following: `and (B) with respect to medical assistance provided for dental benefits for adults but only if such benefits cover the full range of dental benefits (including orthodontia and dentures)'.

(b) Effective Date- The amendments made by subsection (a) shall apply to medical assistance for items and services furnished on or after the date of the enactment of this Act, regardless of whether the State medicaid plan provided for full adult dental benefits before such date.

SEC. 6. ESTABLISHMENT OF FUND FOR ORAL HEALTH SERVICES THROUGH COMMUNITY-BASED HEALTH CENTERS.

(a) In General- There is established in the Treasury of the United States a fund to be known as Community Oral Health Expansion Fund (referred to in this section as the `Fund'). The Fund shall consist of such amounts as may be appropriated under subsection (b) to the Fund. Amounts appropriated for the Fund shall remain available until expended.

(b) Authorization of Appropriations to Fund- For each fiscal year beginning with fiscal year 2006, there is authorized to be appropriated to the Fund $140,000,000.

(c) Use of Fund-

(1) IN GENERAL- Amounts in the Fund and available pursuant to appropriations Act shall be used by the Secretary of Health and Human Services to make grants to the States for the purpose of establishing or expanding the availability of oral health services through Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act), through school-based provision of health services, or through other nonprofit private or public community-based providers of health services.

(2) CERTAIN USES- The purposes for which a grant under paragraph (1) may be expended include, with respect to oral health services--

(A) recruiting and compensating staff;

(B) purchasing equipment; and

(C) constructing, modernizing, or renovating facilities.

(3) USE FOR DEMONSTRATION PROJECTS- In conjunction with any of the uses specified under paragraph (2), grants under paragraph (1) also may be used by health centers and other community-based providers described in paragraph (1) for demonstration projects and demonstration partnerships with Head Start programs for identifying children at risk of dental disease and providing early intervention and prevention of such disease.

(d) Requirement of Matching Funds-

(1) IN GENERAL- With respect to the costs of the program to be carried out under subsection (c) by a State, a grant under such subsection may be made only if the State agrees to make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 10 percent of such costs ($1 for each $9 of Federal funds provided in the grant).

(2) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.

(e) Priority for States Covering Medicaid Level of Dental Benefits Under SCHIP and Preference for States With Market-Based Payment Rates for Dental Services Under Medicaid and SCHIP- In awarding grants to States under this section, the Secretary of Health and Human Services shall--

(1) give priority to those States that provide, under its State child health insurance plan under title XXI of the Social Security Act, for the coverage of dental benefits in an amount, duration, and scope equivalent to that provided under its State medicaid plan under title XIX of such Act; and

(2) give preference to States that provide for reimbursement under its State medicaid plan and its State child health insurance plan under titles XIX and XXI of such Act for dental services at levels consistent with market-based rates.

(f) State Defined- For purposes of this section, the term `State' has the meaning given such term for purposes of title XIX of the Social Security Act.

END