Bill
HB 2554
Illinois Medicaid would raise reimbursement for key pediatric dental services by 33% starting Jan 1, 2026, improving provider payment and access.
Status and introduction
- Bill number: HB 2554
- Short title: MEDICAID‑DENTAL COMPREHENSIVE
- Sponsor: Rep. Joyce Mason (primary)
- Introduced: Early February 2025 (filed Feb. 6, 2025; introduced in the House in early Feb.)
- Current status: Re‑referred to House Rules Committee (Rule 19(a))
- Affects statute: Amends the Medical Assistance Article of the Illinois Public Aid Code (305 ILCS 5/5‑5)
- Effective date in bill: January 1, 2026
Purpose and intent
- To increase reimbursement rates paid through Illinois Medicaid for a set of pediatric dental services, with the intent of improving provider payment for children's dental care and, implicitly, access to pediatric dental services for Medicaid enrollees.
Key provisions
- Amends 305 ILCS 5/5‑5 (medical services) to require a rate increase for specified children’s dental services.
- On and after January 1, 2026, reimbursement rates for the following services shall be increased by 33% above the rates in effect on December 31, 2025:
- Children's comprehensive oral exams
- Periodic oral exams
- Problem‑focused exams
- Behavior management codes
- Sealants
- Resin‑based composites (posterior teeth)
- Extraction and surgical extraction codes
- The bill specifies the increase as a statutory change to the Medical Assistance Article; it sets an effective date rather than an administrative directive.
Who would be affected
- Primary beneficiaries: Children enrolled in Illinois Medicaid/Children’s Health Insurance Program (CHIP) receiving the listed dental services.
- Providers: Dentists and dental clinics serving Medicaid children — higher rates could improve provider participation and reduce access barriers.
- Payers/budget: Illinois Medicaid program (Department of Healthcare and Family Services) and state budget — increases in provider rates will raise program expenditures. A portion of the cost may be federally matched (FMAP), depending on federal approval and applicable rules.
Procedural and implementation notes
- The bill is a statutory rate change; implementation will require administrative steps by the Department of Healthcare and Family Services, including updated fee schedules.
- Depending on the nature of the rate change, federal approval (CMS) or an amendment to the Illinois Title XIX State Plan may be required to secure federal matching funds for the increased payments.
- No fiscal note or cost estimate is included in the bill text provided; total budget impact will depend on service utilization and the share of affected claims.
- Timeline: statutory effective date January 1, 2026. Further legislative committee action and floor votes are required for enactment.
Additional note
- The document provided also contained unrelated text from another state’s HB 2554 (Arizona), which would appropriate $5 million for tribal domestic violence shelter beds; that language appears to be from a different bill and is not part of the Illinois Medicaid bill summarized above.
Compiled from official sources — confirm details with the bill’s official record.
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