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Senate committee hears testimony on adding medically necessary dental care to Medicaid expansion under SB 2231
Summary
Lawmakers and providers discussed Senate Bill 2,231, which would add medically necessary dental services to North Dakota's Medicaid expansion benefits for adults, focusing on eligibility, fiscal impact and access constraints. Committee postponed final action to a later meeting.
Senator Heidi Heitkamp Lee, sponsor of Senate Bill 2,231, asked the Senate Appropriations Committee's Human Resources Division on Wednesday to add "medically necessary dental services" to the Medicaid expansion benefit for adults, saying dental treatment should follow the screening and assessment already proposed in the bill.
The bill would cover adults 19 through 64 eligible under Medicaid expansion (income up to 138% of the federal poverty level), and the Fiscal Note presented during the hearing projected additional costs for the biennium. Senator Lee said the fiscal note before the committee was "$513,940 in general funds, and $4,600,000 in other funds for this biennium" and urged members to consider the treatment component alongside assessments.
The committee heard technical and policy comments from Sarah Acre, Executive Director of the Division of Medical Services at the North Dakota Department of Health and Human Services, who described the population eligible under Medicaid expansion and confirmed the federal match. "Because Medicaid expansion has a ninety-ten federal match, the 10% of the total, which for the biennium is estimated to be $5,138,404. The approximate general fund cost of that would be about 500,000," Acre said, summarizing the administration's estimate and the share the state would pay.
Lawmakers pressed on access and capacity. Committee members and witnesses noted that many existing dental providers do not accept Medicaid, enrollment in Medicaid is voluntary for dentists, and access varies widely across the state. Acre said the department maintains an online list of dentists who accept Medicaid and that North Dakota's dental reimbursement rates have fallen in national rankings, although they remain relatively high regionally.
Representatives of safety-net providers and clinics described current demand and capacity constraints. Kim Coleman of the Community Healthcare Association of the Dakotas said federally qualified health centers (FQHCs) already treat Medicaid and uninsured patients and that adding coverage for Medicaid expansion patients would help centers that currently provide care without reimbursement. "There are about 36,000 individuals at 22 locations in 20 communities across the state that are treated at federally qualified health centers," Coleman said.
Nadine Bowe, CEO of Northland Health Centers, described recruiting challenges and the sliding-fee models FQHCs use to serve low-income patients. Bowe said some remote sites now have dental suites but that recruiting dentists to rural communities requires paying competitive salaries. She said an FQHC dental clinic in Minot is around 60% Medicaid and that the center would likely need additional revenue to expand services.
Tammy King, executive director of Bridging the Dental Gap in Bismarck, said her nonprofit clinic sees patients statewide and routinely treats people who travel long distances because few providers accept Medicaid. King gave a recent example of a patient on Medicaid expansion who could not afford a $50 appointment fee and whose case manager had called the clinic because the patient was in acute pain and could not get routine treatment elsewhere.
Testimony also addressed whether the state can rely on the federal match and how appropriation triggers would be handled. Several senators asked for additional materials; Sarah Acre agreed to provide charts on income eligibility levels and a short glossary of acronyms used in Medicaid program materials. Providers said they support the bill with the committee amendment that would phrase the benefit as "medically necessary dental services."
No formal vote occurred. The committee chair said the panel was not yet a full committee and moved to set the bill aside for further work, indicating senators would take the item up again the next day or later in the week. "So committee with that, I don't see senator Davidson returning. So let's take this bill up tomorrow," the chair said, and the meeting adjourned.
Why it matters: Dental care advocates and safety-net providers told the committee that adult oral health affects broader health outcomes and health-care utilization. Proponents argued a comparatively small state investment could draw federal funds that expand access; opponents and some committee members asked for more information on capacity, exact costs, and administrative details before committing general fund dollars.
