Modernize Medicaid Dental Rates.

2025-2026 Session Introduced by Jonathan Almond and 58 co-sponsors

The bill raises Medicaid dental reimbursements from about 35% to 46% of 2023 average charges, aiming to improve access and provider participation.

Passed 1st Reading

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HB 60 — Modernize Medicaid Dental Rates (North Carolina)

Status and timing
- Bill title: Modernize Medicaid Dental Rates (HB 60).
- Sponsor(s): Rep. Josh (John) Biggs; primary sponsors listed also include Lambeth, Potts, and Cotham.
- Filed/referred: Introduced in early 2025; effective date provided in the bill: July 1, 2025.
- Implementation: Rate increases to be implemented “as soon as practicable after July 1, 2025.”

Purpose / intent
- Increase Medicaid reimbursement for dental services to improve access to preventive and routine dental care, reverse declining provider participation, and reduce downstream health costs associated with untreated oral disease. The bill frames the change as correcting 15 years of unadjusted reimbursement relative to inflation and peer-state rates.

Key provisions
- Appropriation: Authorizes recurring General Fund appropriations of $52,000,000 per year for each year of the 2025–2027 biennium to the Department of Health and Human Services (DHHS), Division of Health Benefits, to raise Medicaid dental rates.
- Federal match: The $52 million state appropriation is intended to match and unlock $95,000,000 in recurring federal Medicaid funds per year (i.e., combined annual funding for the rate increase of roughly $147 million).
- Rate target: Raises Medicaid dental reimbursement for providers from an estimated 35% to 46% of the “average dentist charges” in 2023 (the bill ties the new rates to that benchmark).
- Administration: DHHS Division of Health Benefits is the implementing agency; the bill directs DHHS to implement the rate increases promptly after the July 1, 2025 effective date.

Who is affected
- Medicaid beneficiaries: Especially low-income children and adults who rely on Medicaid dental coverage — expected improved access to preventive and routine dental care.
- Dental providers: Higher reimbursement is intended to increase participation in the Medicaid program and improve provider willingness to accept Medicaid patients.
- State budget / DHHS: A recurring General Fund cost of $52 million annually (plus administrative activity for implementation); additional federal spending authority of $95 million per year is expected to be drawn down.
- Federal Medicaid program: The bill relies on federal matching funds; federal participation subject to Medicaid rules and federal approval of state plan or SPA changes if required.

Fiscal and programmatic impact (summary)
- Direct recurring State appropriation: $52 million/year (2025–27 biennium language).
- Expected additional federal match: $95 million/year (recurring).
- Net effect: Increased annual Medicaid spending (~$147 million/year combined) to raise dental rates; DHHS to manage implementation and provider rate changes.

Notes / implementation considerations
- The bill sets a percentage-of-average-charge target but does not detail the precise rate-setting methodology or schedule; DHHS will need to operationalize rate calculations and may require regulatory or plan amendments.
- Long-term program impacts (e.g., changes in utilization, provider participation, and downstream health spending) are plausible but not specified in the bill and would depend on implementation details and provider response.