HB 547
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader
House Bill 547 (Delegate R. Lewis)
Health and Government Operations Finance
Maryland Medical Assistance Program – Dental Prophylaxis Care and Oral
Health Exams
This bill prohibits Medicaid, beginning January 1, 2022, from including a frequency
limitation on covered dental prophylaxis care (dental cleanings) or oral health exams that
requires those services to be provided at an interval greater than 120 days within a
plan year. Thus, Medicaid may require that dental preventive care be limited to no more
than once every four months. This prohibition is subject to federal approval and the
limitations of the State budget.
Fiscal Summary
State Effect: To the extent the bill increases the amount of dental prophylaxis or oral
health exams provided to Medicaid enrollees, Medicaid expenditures (54% federal funds,
46% general funds) increase beginning in FY 2022, as discussed below. Federal fund
revenues increase accordingly. This bill increases the cost of an entitlement program
beginning in FY 2022.
Local Effect: None.
Small Business Effect: Potential meaningful.
Analysis
Current Law: Comprehensive dental coverage is mandatory for children enrolled in
Medicaid. However, dental benefits for most Medicaid-eligible adults are optional. The
Maryland Healthy Smiles Dental Program covers children younger than age 21, former
foster care recipients younger than age 26, pregnant women age 21 and older, and adults
enrolled in the Rare and Expensive Case Management (REM) program. For other Medicaid
enrollees, dental coverage is only for emergency care. For enrollees in managed care
organizations (MCOs), some limited dental benefits are offered on a voluntary basis by
MCOs, but costs associated with those benefits are not reimbursed by Medicaid.
Chapter 621 of 2018 required the Maryland Department of Health to establish a pilot adult
dental program. In response, Medicaid proposed a limited benefit program (basic
diagnostic and preventive coverage with limited restorative and extractive services) for
adults ages 21 to 64 who are dually eligible for both Medicare and Medicaid
(“dual-eligibles”). The program began in June 2019.
Under § 15-135.1 of the Insurance Article, insurers, nonprofit health service plans, health
maintenance organizations, and dental plan organizations that provide dental benefits on
an expense-incurred basis may not impose a frequency limitation that requires such care
be provided at an interval greater than 120 days during a plan year.
State Fiscal Effect: Under the Maryland Healthy Smiles Dental Program, dental
prophylaxis is limited to one per patient every three months for children and adults in REM,
and one per patient every six months for all other children, former foster care youth, and
pregnant women. Periodic oral evaluations are limited to one per patient per provider or
location per six-month period for all patients. Under the pilot adult dental program, dental
prophylaxis care is limited to one per patient per six-month period. Periodic oral
evaluations are also limited to one per patient per six-month period. All nine MCOs cover
dental prophylaxis and oral examinations twice a year; however, as noted above, this
coverage is provided on a voluntary basis.
Impact on Dental Costs for Adults in Medicaid
As adults in REM may currently receive dental prophylaxis once every three months and
services under the adult dental pilot program are limited to an $800 benefit allowance
per year, the bill likely has no meaningful impact on Medicaid expenditures for dental
services for adults.
Impact on Dental Costs for Children in Medicaid
According to Medicaid, in calendar 2019, 408,862 children ages 4 to 20 with any length of
Medicaid enrollment received a preventive or diagnostic dental service (55.8% of the
733,128 children enrolled). For those with at least 320 days of enrollment in Medicaid,
63.8% of children received a preventive or diagnostic dental service. Medicaid advises that
utilization of preventive services by children increases under the bill. Specifically,
Medicaid estimates that an additional 58,847 children ages 4 to 20 will receive preventive
services under the bill, including one additional oral evaluation and prophylaxis per year
HB 547/ Page 2
at a cost of $71.45. Thus, Medicaid expenditures increase by $4.6 million (54% federal
funds, 46% general funds) annually.
The Department of Legislative Services disagrees and notes that, while utilization may
increase, the extent of such an increase cannot be reliably estimated but is not likely to be
as significant.
For illustrative purposes only, based on calendar 2019 data, if an additional 1% of children
who received preventive services in calendar 2019 receive one additional oral evaluation
and prophylaxis under the bill, Medicaid expenditures increase by $292,132 ($134,381 in
general funds) annually; if an additional 5% of children receive one additional oral
evaluation and prophylaxis under the bill, Medicaid expenditures increase by $1.5 million
($671,903 in general funds) annually; if an additional 10% of children receive
one additional oral evaluation and prophylaxis under the bill, Medicaid expenditures
increase by $2.9 million ($1.3 million in general funds) annually. Federal fund revenues
increase accordingly.
Small Business Effect: Small business dental providers benefit from the ability to provide
dental prophylaxis and oral health exams more frequently.
Additional Information
Prior Introductions: None.
Designated Cross File: SB 485 (Senator Augustine) - Finance.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - February 5, 2021
rh/ljm Third Reader - March 2, 2021
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 547/ Page 3


Statutes affected:
Text - First - Maryland Medical Assistance Program – Dental Prophylaxis Care and Oral Health Exams: 15-103 Health General
Text - Third - Maryland Medical Assistance Program – Dental Prophylaxis Care and Oral Health Exams: 15-103 Health General