Summary — HB 1567
Title: An act to provide for a legislative management study relating to dental and oral health care status among Medicaid recipients and workforce support to improve access for low‑income children, Native American children, and individuals with disabilities.
Status & Timeline
- Filed with Secretary of State: 04/17 (as provided)
- Study period: 2025–26 interim (to be conducted by Legislative Management)
- Report due: Findings, recommendations, and any implementing legislation to be reported to the 70th Legislative Assembly
- Appropriation period: Biennium July 1, 2025 – June 30, 2027
Purpose / Intent
HB 1567 directs Legislative Management to study unmet dental and oral health needs and access barriers affecting Medicaid recipients — with particular focus on low‑income children, Native American children (on/off reservations), and individuals with disabilities — and to identify workforce and system supports to improve access.
Key Provisions
1. Scope of the required study (topics to be examined include, but are not limited to):
- Current dental/oral health status of Medicaid recipients (including regional and reservation differences).
- Health consequences and downstream costs of unmet dental needs.
- State and federal rules, credentialing, enrollment and recredentialing processes, provider terminations, prior authorization practices, appeals, attachments, and timeliness of payments that affect dentist participation in Medicaid.
- Availability and barriers to complex dental care for people with disabilities and procedures requiring anesthesia/critical care.
- Comparison of Medicaid dental reimbursement rates for selected preventive and treatment services against other states and private payers; assessment of cost adequacy.
- Education/workforce strategies (dental school capacity, regional partnerships, student residencies, on‑the‑job training, apprenticeships for dental assistants).
- Expansion/creation of volunteer/charitable dental services and nonprofit programs.
- Opportunities for partnerships with tribal health organizations and use of telehealth to reach rural and tribal communities.
- Provider participation with insurers, benefit coverage, out‑of‑pocket costs, preauthorization adherence to ADA/AAPD clinical guidelines.
- Program administration topics: provider relations, call center performance (volume, hold time, satisfaction), grievance/appeal processes, peer review composition, quality improvement systems.
- Analysis of EPSDT (CMS Form 416) metrics (percent of eligible children receiving dental services, preventive services, sealants).
- Ambulary surgery/hospital claims for dental procedures requiring monitored anesthesia in children.
Additional study flexibility:
- May broaden to unmet needs for all Medicaid recipients.
- May include remediation plans with goals, costs, and implementation timelines.
- May examine scope‑of‑practice changes and additional provider types as solutions.
Appropriation:
- $97,000 (general fund) is appropriated to the Department of Health and Human Services for the oral health program to support student rotations statewide (including community health centers serving Native American populations) and dental student recruitment for the 2025–27 biennium.
Who Is Affected
- Primary: Medicaid enrollees — low‑income children, Native American children (on/off reservations), and individuals with disabilities.
- Secondary: Dentists and dental teams, dental education programs, community health centers, tribal health organizations, state Medicaid/administrative staff, and policymakers.
Potential Impact
- The study is intended to produce an evidence base and actionable recommendations (including possible legislative changes) to address access gaps, provider participation barriers, workforce shortages, reimbursement adequacy, and service delivery improvements — especially for rural, tribal, and disability‑focused populations. The $97,000 appropriation is a targeted investment to expand student clinical rotations and recruitment efforts, which may help long‑term workforce capacity.
