HR-10676-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Sydney Kamlager-Dove (D-CA)
What it does
The bill would extend Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit from age 21 to age 26 for "specified individuals": people currently in foster care, or people who were in foster care at age 18 (or the higher age a state elects) and were then enrolled in Medicaid. It would require state Medicaid programs to pay dentists at least a "specified average rate" based on average commercial insurer contracted rates over five years for dental services to these individuals, with the state choosing a state-level or national average. The federal government would pay 100 percent of the added cost above each state's January 1, 2026 dental payment rates, and states would have to set up outreach and enrollment programs for eligible former foster youth and outreach to dentists within 6 months. Most provisions would start about 80 days after enactment.
Who benefits
Former foster youth ages 21 to 25 enrolled in Medicaid, who would gain EPSDT coverage including dental care. Dentists who treat them, who would be paid at least the average commercial contracted rate. State Medicaid programs, which would receive 100 percent federal funding for the added dental payment costs. Child welfare agencies and community clinics, which may find it easier to refer young adults to dentists who accept Medicaid.
Who is hurt
Federal taxpayers, who would bear the full cost of the dental rate increases above January 1, 2026 levels and the extended EPSDT services. State Medicaid agencies, which would face administrative costs for outreach and enrollment programs and for rate changes, and which would pay their usual share of the extended EPSDT services. Dentists and patients outside this group, who would see a payment differential favoring one population. Managed care plans, which would have to meet the new minimum payment rate and may need to adjust their contracts.
Supporters argue
Supporters argue that former foster youth face high rates of unmet dental need and that few dentists accept Medicaid because its payment rates are low. They contend that paying commercial-level rates, fully funded by the federal government, would widen dentist participation, while extending EPSDT to age 26 would fill a gap in coverage during the difficult transition to adulthood. They also point to the outreach requirements as a way to enroll eligible young adults who currently go uncovered.
Opponents argue
Opponents argue that the bill would raise federal spending and create a payment rate for one narrow group, adding complexity to Medicaid's rate-setting and to managed care contracts. They contend that tying rates to commercial averages could set a precedent for other groups and services, and that 100 percent federal funding weakens state incentives to control costs. They also argue that higher rates alone may not increase dentist participation, since administrative burden and other factors also deter providers.
Constitutional context
The bill rests on Congress's Spending Clause power (Art. I, §8, cl. 1) to set conditions on Medicaid funds. NFIB v. Sebelius (2012) limits coercive funding conditions on states, but this bill adds benefits backed by full federal funding for the added dental costs and does not threaten existing Medicaid funds, so a coercion issue appears unlikely.
Checks and balances
Congress would expand program requirements and federal spending, HHS and CMS would implement and set outreach best practices, and states would administer the benefit within the new rules; oversight comes through appropriations, committee review, and CMS enforcement.
Historical precedent
The Affordable Care Act's Medicaid primary care payment bump (1902(a)(13)(C)) temporarily raised primary care rates to Medicare levels with full federal funding, and the ACA also extended Medicaid coverage to former foster youth up to age 26.