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S 5091

Medicaid Dental Benefit Act of 2026

119th Congress Introduced by Angela Alsobrooks

Medicaid would mandatorily cover comprehensive adult dental and oral health services starting in 2028, with increased federal funding and new quality, reporting, and outreach requi

Introduced in Senate
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WeVote Research Nonpartisan
Bill Summary · S 5091

Overview

S.5091, the Medicaid Dental Benefit Act of 2026, aims to expand and enhance dental and oral health coverage for adults enrolled in Medicaid. Introduced in the 119th Congress by Senator Alsobrooks (co-sponsored by Angela Alsobrooks), the bill would make dental and oral health services mandatory for adults under Medicaid starting in 2028, adjust federal financing to support these benefits, create adult oral health quality measures, and establish outreach and reporting requirements.

Main purpose and intent

  • Ensure comprehensive dental and oral health services for adult Medicaid enrollees.
  • Expand federal support (FMAP) for expenditures related to adult dental and oral health benefits.
  • Develop a standardized set of adult oral health quality and equity measures and require States to report on them.
  • Promote awareness, access, and culturally competent care through outreach, education, and provider training.

Key provisions and changes

1) Mandatory coverage for adults

  • Amends several sections of the Social Security Act to require Medicaid to cover dental and oral health services for adults (defined to include dentures, implants, preventive and restorative care, and emergency/trauma treatments, among other services).
  • Effective date for the mandatory coverage and related amendments: calendar quarters beginning January 1, 2028.
  • Defines dental and oral health services to include preventive, restorative, and emergency care furnished by providers authorized under State law.

2) Scope and optional enhancements for states

  • States may opt to provide additional dental and oral health benefits beyond the core set defined in the bill.

3) Increased FMAP (federal financial participation)

  • Temporarily increases the FMAP to 100% for the dental and oral health services described under the bill for the 12 quarters starting January 1, 2028, for all states and DC (with caps not exceeding 100%).
  • Territories (Puerto Rico, VI, Guam, Northern Mariana Islands, American Samoa) would also receive 100% FMAP for these expenditures during a defined 12-quarter period after coverage begins.
  • Exclusions apply to certain items; other existing FMAP and territorial cap rules remain in effect for other expenditures.

4) Adult oral health quality and equity measures

  • Creates a new Section 1139C in Title XI to develop a core set of adult oral health quality and equity measures.
  • Measures would align with existing adult health quality measures and cover:
    • Utilization of services across settings
    • Availability of oral health evaluations during medical visits
    • Emergency department visits for non-traumatic dental conditions
    • Follow-up care after ED visits for dental conditions
    • Counseling and preventive care
    • Access to anesthesia/sedation when medically necessary
    • Caries risk assessment, fluoride/sealant use, periodontal evaluations, and management of periodontitis
  • Timelines include:
    • Identification and public comment within 1 year of enactment
    • Initial core measures published within 1 year
    • Standardized reporting format and guidelines within 2 years
    • Congress reporting every 3 years thereafter

5) Annual state reporting and public data

  • States would annually report on:
    • State-specific adult oral health measures and quality data
    • Availability and limits of dental benefits
    • Equity-focused data (disaggregated by race, ethnicity, language, disability status, gender identity, etc.)
  • Secretary to publish state data publicly within 2 years and then annually.

6) Public outreach and education

  • Establishes a federal program (via HHS contracting with eligible entities) to:
    • Provide culturally competent, linguistically appropriate information about adult dental coverage
    • Help vulnerable populations connect with oral health care
    • Educate providers to improve competencies in delivering equitable adult oral health care

Who is affected

  • Medicaid adult enrollees (21 and older) nationwide (including state/territory populations).
  • States and the District of Columbia (responsible for administering benefits, reporting, and potentially expanding services).
  • Dental and medical providers who furnish covered services.
  • Federal and state program administrators, researchers, and quality measurement organizations.

Procedural and timeline notes

  • Effective date for mandatory coverage and FMAP changes: for calendar quarters beginning on/after January 1, 2028.
  • FMAP increase applies for a 12-quarter period for the covered dental and oral health services.
  • Requires new reporting under Medicaid and CHIP-PA (for CHIP) and annual/state reporting to the Secretary.
  • New authorization of appropriations: $10 million, available until expended, to support implementation of the new adult oral health measures and related activities.
  • A comprehensive adult oral health report to Congress is due within 3 years, with updates every 3 years thereafter.

Potential impact

  • Expanded access to comprehensive adult dental care under Medicaid.
  • Greater emphasis on oral health quality and equity, with standardized metrics and public reporting.
  • Increased federal funding support for expanded adult dental benefits, particularly in the early years.
  • Greater focus on reducing disparities in adult oral health outcomes through data-driven policies and outreach.

Compiled from official sources — confirm details with the bill’s official record.

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