This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1177b.HHS
DATE: 4/18/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1177 Dental Care
SPONSOR(S): Healthcare Regulation Subcommittee, Bell and others
TIED BILLS: IDEN./SIM. BILLS: SB 1000
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N, As CS Osborne McElroy
2) Health & Human Services Committee 19 Y, 0 N Guzzo Calamas
SUMMARY ANALYSIS
The Florida Medicaid program provides state- and federally-funded health coverage, including dental services,
to low-income and disabled Floridians. Generally, the program operates under a comprehensive, integrated
managed care model, except for dental services, which are provided through separate dental-only managed
care plans. Medicaid plans may choose to contract with any provider meeting standard Medicaid requirements,
except as directed by law.
Mobile dental units are used to expand access to dental care to individuals without dental coverage who may
also live in rural areas. Current law limits the use of mobile dental units in Medicaid. Medicaid reimbursement is
only available for dental services provided by mobile dental units owned or operated by, or under contract with,
a county health department, Federally Qualified Health Center FQHC, state-approved dental educational
institution, or a mobile dental unit providing adult dental services at a nursing home.
The Head Start program is a federally funded, income-based program that provides free educational and
comprehensive services, including dental care, to pregnant mothers and children through age 5.
The bill authorizes Medicaid reimbursement for dental services provided by other types of mobile dental units,
including a mobile dental unit who contracts with a nonprofit community health center or a federally approved
Head Start center.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2023.
STORAGE NAME: h1177b.HHS PAGE: 2
DATE: 4/18/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Florida Medicaid
Medicaid is the health care safety net for low-income Floridians. Medicaid is a partnership of the federal
and state governments established to provide coverage for health services for eligible persons. The
program is administered by the Agency for Health Care Administration (AHCA) and financed by federal
and state funds. AHCA delegates certain functions to other state agencies, including the Department of
Children and Families (DCF), the Department of Health (DOH), the Agency for Persons with
Disabilities, and the Department of Elderly Affairs (DOEA).
The structure of each state’s Medicaid program varies, and what states must pay for is largely
determined by the federal government as a condition of receiving federal funds.
1
Federal law sets the
amount, scope, and duration of services offered in the program, among other requirements. The federal
government sets the minimum mandatory populations to be included in every state Medicaid program.
The federal government also sets the minimum mandatory benefits to be covered in every state
Medicaid program. These benefits include physician services, hospital services, home health services,
and family planning.
2
States can add benefits, with federal approval; Florida has added many optional
benefits, including adult dental services.
Statewide Medicaid Managed Care (SMMC)
Florida delivers medical assistance to most Medicaid recipients – approximately 78% - using a
comprehensive managed care model, the SMMC program.
3
The SMMC program was intended to
provide comprehensive, coordinated benefits coverage to the Medicaid population, leveraging
economic incentives to ensure provider participation and quality performance impossible under the
former, federally prescribed, fee-for-service delivery model.
The SMMC program has three components: the integrated Managed Medical Assistance (MMA)
program that provides primary care, acute care and behavioral health care services; Long-Term Care
(LTC) program
4
that provides long-term care services, including nursing facility and home and
community-based services; and the dental component.
Dental Services
While most Medicaid services are provided by comprehensive, integrated, managed care plans, dental
services are provided by separate, dental-only, plans. Medicaid covers dental benefits for both
children
5
and adults. Medicaid covers full dental services for children.
6
Adult dental benefits are limited
to emergency treatment and dentures, and do not include preventive services.
7
However, Medicaid
1
Title 42 U.S.C. §§ 1396-1396w-5; Title 42 C.F.R. Part 430-456 (§§ 430.0-456.725) (2016).
2
S. 409.905, F.S.
3
Agency for Health Care Administration, Florida Statewide Medicaid Monthly Enrollment Report, December 2021, available at
https://ahca.myflorida.com/medicaid/Finance/data_analytics/enrollment_report/index.shtml (last visited March 31, 2023). United States
Census Bureau, QuickFacts, Florida, https://www.census.gov/quickfacts/fact/table/FL/PST045221 (last visited March 31, 2023).
4
The LTC program provides services in two settings: nursing facilities or home and community-based services (HCBS) provided in a
recipient’s home, an assisted living facility, or an adult family care home. Enrollment in the LTC program is based on a clinical priority
system and includes a wait list. The state is approved for 62,000 recipients in the HCBS portion of LTC. In order to be eligible for the
program, a recipient must be both clinically eligible under s. 409.979, F.S., and financially eligible for Medicaid under s. 409.904, F.S.
5
Under the age of 21.
6
S. 409.906(6), F.S.
7
S. 409.906(1), F.S. STORAGE NAME: h1177b.HHS PAGE: 3
DATE: 4/18/2023
dental plans provide expanded dental benefits to adults, including preventive and restorative dental
services at no cost to the state.
8
The chart below indicates the covered dental services.
9
Children Adults
Ambulatory Surgical
Center or Hospital-based
Dental Services
Orthodontics
Dental Exams
(emergencies and
dentures only)
Dental Exams Periodontics Dental X-rays (limited)
Dental Screenings
Prosthodontics
(dentures)
Prosthodontics
(dentures)
Dental X-rays Root Canals Extractions
Extractions Sealants Sedation
Fillings and Crowns Sedation
Ambulatory Surgical
Center or Hospital-based
Dental Services
Fluoride Space Maintainers
Oral Health Instructions Teeth Cleanings
Dental services under the SMMC program may be provided by a:
10
Licensed dentist or dental hygienist;
County health department administered by DOH;
Federally qualified health center (FQHC);
11
or a
Dental intern or a dental graduate temporarily certified to practice in a state operated hospital or
a state or county government facility in accordance with s. 466.025, F.S.
Dental Performance Measures
Medicaid performance measures in dental services for children are poor. The most recent data, for
2019, indicates 50% of Florida Medicaid children enrolled in a dental plan received an annual dental
visit, compared to the national mean of 55.5%. Similarly, 39% of Medicaid children enrolled in a dental
plan received a preventive dental service, compared to the national mean of 49%.
12
Mobile Dental Units
Mobile dental units are used to expand access to dental care to individuals without dental coverage
who may also live in rural areas. Current law limits the use of mobile dental units in Medicaid. Section
409.906, F.S., authorizes Medicaid reimbursement only for certain types of mobile dental units,
including mobile dental units owned or operated by, or under contract with, a county health department,
FQHC, state-approved dental educational institution, or a mobile dental unit providing adult dental
services at a nursing home.
13
Current law does not authorize Medicaid coverage of dental services provided by a mobile dental unit
contracting with a nonprofit community health center or a federally-approved Head Start center.
8
Agency for Healthcare Administration, Agency Analysis of 2023 HB 1177 (March 9, 2023).
9
Florida Medicaid, Dental Services Coverage Policy (August 2018), available at
https://ahca.myflorida.com/content/download/5945/file/59G-4.060_Dental_Coverage_Policy.pdf (last visited March 31, 2023).
10
Id.
11
A federally qualified health center is a federally funded nonprofit health center or clinic that serves medically underserved areas and
populations regardless of an individual’s ability to pay. See Federally Qualified Health Center, HealthCare.gov, available at
https://www.healthcare.gov/glossary/federally-qualified-health-center-fqhc/ (last visited March 31, 2023).
12
Supra note 8.
13
S. 409.906(1)(c) and (6)(a)-(d), F.S. STORAGE NAME: h1177b.HHS PAGE: 4
DATE: 4/18/2023
Head Start Program
The Head Start program is a federally funded, income-based program that provides free educational
and comprehensive services, including dental care,
14
to pregnant mothers and children through age
5.
15
The program is administered by the Florida Head Start State Collaboration Office in partnership with
the Division of Early Learning (within the Department of Education), and the Florida Head Start
Association. Currently, there are 579 federally approved Head Start Centers in Florida.
16
Federally Qualified Health Centers
A Federally Qualified Health Center (FQHC), also known as a community health center, is a federally
funded safety net provider that provides primary and preventive health services, including pediatric
dental screenings to determine the need for dental care and preventive dental care services.
17
Community health centers serve populations that are medically underserved, either through the staff
and supporting resources of the center or through contracts or cooperative arrangements.
18
Currently,
there are 588 community health centers in Florida.
19
Effect of the Bill
The bill authorizes Medicaid reimbursement for dental services provided by other types of mobile dental
units. Specifically, the bill allows Medicaid reimbursement for dental services provided by a mobile
dental unit who contracts with a nonprofit community health center or a federally approved Head Start
center. However, the bill does not require Medicaid dental plans (or fee-for-service Medicaid) to
contract with or pay for dental services provided by mobile dental units contracted by these entities.
If more children can access dental care through additional mobile units contracted by nonprofit
community health centers and Head Start centers, the Medicaid program’s performance regarding
children’s dental services may improve.
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: Amends s. 409.906, F.S., relating to optional Medicaid services.
Section 2: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
14
U.S. Department of Health & Human Services, Office of Head Start-Services for Children and Families-Health and Wellness,
available at https://www.acf.hhs.gov/ohs/about/head-start (last visited March 31, 2023).
15
Florida Department of Education, Division of Early Learning, Florida Head Start State Collaboration Office, available at
https://www.floridaearlylearning.com/statewide-initiatives/head-start (last visited March 31, 2023).
16
U.S. Department of Health & Human Services, Head Start Early Childhood Learning & Knowledge Center, Head Start Center
Locator, available at https://eclkc.ohs.acf.hhs.gov/center-locator?latitude=27.665&longitude=-81.516&state=FL&type=1 (last visited
March 31, 2023).
17
42 U.S.C. §254b.
18
Id.
19
Florida Association of Community Health Centers, Find a Health Center, available at https://fachc.org/find-a-health-center/ (last
visited March 31, 2023). STORAGE NAME: h1177b.HHS PAGE: 5
DATE: 4/18/2023
2. Expenditures:
None. While the bill authorizes Medicaid plans (and fee-for-service Medicaid) to contract with
additional types of mobile dental units, it does not require them to do so. If a contract is executed
with an additional provider, and that contract increases a plan’s provider network or that provider is
in a more accessible location than current network providers, then the program may experience
additional utilization.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
AHCA has sufficient rule-making authority to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES