Committee hears broad support to add adult dental benefit to Medicaid expansion

Senator Judy Lee, sponsor: For the record, Senator Judy Lee (District 13), told the House Human Services Committee Senate Bill 2231 would add medically necessary dental services to the Medicaid expansion population and that dental services found necessary through screening and teledentistry should be paid through Medicaid expansion.

Why it matters: Supporters said including adult dental care in the Medicaid expansion benefit would close an existing coverage gap, bring federal dollars into the state health system and reduce costly emergency-room visits for tooth pain.

Several community health center leaders, including Kim Kuhlman, policy and partnership manager for the Community Healthcare Association of the Dakotas (CHaD), told the committee: “We are here today in support of SB 2,231 as passed by the Senate.” Kuhlman said the bill would “add an adult dental benefit under Medicaid expansion, which would be the same coverage as currently covered under traditional Medicaid and would ensure that expansion enrollees have coverage for medically necessary dental care.”

Health-center CEOs described local demand. Nadine Bowe, CEO of Northland Health Centers, said her clinics have opened urgent dental access sites to meet need and stressed those efforts will face recruitment and sustainability challenges without Medicaid reimbursement for expansion enrollees. Mara Duran, CEO of Spectra Health in Grand Forks, said recent demand has “skyrocketed” and that clinics often absorb uncompensated care when expansion patients have no dental benefit.

The North Dakota Dental Association’s executive director William Sherwin told the committee community health centers and private dentists stand ready to provide care if the benefit is added. Sherwin noted national estimates of emergency-room spending on oral health and argued that treating patients in dental settings would be more effective and less costly than repeated ER visits.

Numbers and local impact: Testimony included several figures from providers and CHaD materials: five community health center organizations operating 22 locations serving about 36,000 individuals; health centers provided dental care to 11,912 patients with more than 25,000 dental visits in 2023; and an estimated 34,000 North Dakotans covered by Medicaid expansion currently lack dental coverage. CHaD emphasized that about 90% of Medicaid expansion funding for covered services would come from the federal match.

Questions and clarifications: Committee members asked whether dental services already are covered for some Medicaid populations; Senator Lee and witnesses clarified that traditional Medicaid includes an adult dental benefit in some categories but Medicaid expansion historically did not include vision or dental. Sarah Aker, executive director of the Division of Medical Services, told the committee that “medically necessary would include things that, kind of match our current dental benefit in our, traditional Medicaid population” and that the bill would exclude cosmetic or experimental procedures.

Implementation concerns raised by lawmakers and witnesses included workforce shortages, recruitment efforts (student rotations and new dental hygiene schools), and the need for sustainable reimbursement to expand dental clinics and hire staff. Witnesses said health centers use strategies such as student rotations and recruitment trips to dental schools to grow the workforce.

Where it stands: Supporters asked for a “do pass” recommendation to allow the bill to proceed. No formal committee vote was recorded in the transcript.

Ending: Proponents asked the committee to include medically necessary dental treatment for adults on Medicaid expansion so the state could reduce avoidable emergency care, improve overall health, and strengthen safety-net dental capacity.