S. 5091 — Medicaid Dental Benefit Act of 2026

This section requires states to cover dental and oral health services for adults under Medicaid beginning January 1, 2028. It defines the services to include dentures, implants, and items and services to prevent oral disease, restore function, reduce pain, and treat emergencies. It raises the federal medical assistance percentage to 100 percent for these services for 12 quarters starting in 2028 for the 50 states, the District of Columbia, and territories. It permits states to cover additional related items and services at their option.

This section establishes a core set of adult oral health quality and equity measures for Medicaid enrollees over age 21. It requires the Secretary of Health and Human Services to publish recommended measures within 1 year that address utilization, emergency visits, follow-up care, caries and periodontitis screening, fluoride applications, evaluations, and extractions; develop standardized state reporting formats within 2 years (stratified by race, ethnicity, language, disability, sexual orientation, and gender identity); and include related information in triennial reports to Congress. States must annually report on their use of these measures.

This section directs the Medicaid and CHIP Payment and Access Commission to submit a report to Congress within 2 years of enactment on adult oral health issues across the 50 states, tribes, and territories. The report must address coverage availability and enrollment, oral health status among low-income women of childbearing age, access barriers for racially and ethnically diverse and limited English-proficient communities, innovations to expand access beyond dental offices, and the effects of section 2 amendments with recommendations for improving Medicaid dental reimbursement rates.

This section directs the Secretary of Health and Human Services to develop, within one year of enactment, a program implemented through contracts with oral health providers and funders to deliver culturally competent and linguistically appropriate information on Medicaid oral health coverage for adults, connect enrollees and underserved populations to care, train dental and medical professionals on serving adults with disabilities, pregnant and postpartum individuals, Alaska Native and American Indian populations, and urban or rural communities, and provide interactive education on oral health practices for racially and ethnically diverse Medicaid adults.