Increasing Medicaid dental provider reimbursement rates

SB 1014 Text

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WEST VIRGINIA LEGISLATURE

FISCAL NOTE

2026
REGULAR SESSION
Introduced
Senate Bill 1014
By Senators Oliverio and Takubo
[Introduced February 19, 2026; referred
to the Committee on Health and Human Resources; and then to the Committee on Finance]
A BILL to amend and reenact §9-5-12a of the Code of West Virginia, 1931, as amended, relating to Medicaid dental care; and increasing Medicaid dental provider reimbursement rates.
Be it enacted by the Legislature of West Virginia:

ARTICLE 5. MISCELLANEOUS PROVISIONS.

§9-5-12a. Medicaid program; dental care.

(a)
Legislative findings. – The Legislature finds the expanded adult dental benefit was established in 2021, funded by the provider tax on health maintenance organization, and the State Medicaid dental benefit expenditures are matched 25:75 with federal funds. The Legislature also finds that Medicaid's Report entitled "Assessment of Medicaid Beneficiaries' Barriers and Facilitators to Utilization of Dental Benefits," published in March 2024, identified that current reimbursement rates make it difficult for providers to cover the cost incurred by providing certain services. The Legislature further finds that the inflation rate over the past three years has significantly affected the cost in providing dental services.
(b)
The following terms are defined:
(1) "Cosmetic services" means dental work that improves the appearance of the teeth, gums, or bite, including, but not limited to, inlays or onlays, composite bonding, dental veneers, teeth whitening, or braces.
(2) "Diagnostic and preventative services" means dental work that maintains good oral health and includes oral evaluations, routine cleanings, x-rays, fluoride treatment, fillings, and extractions.
(3) "Restorative services" means dental work that involves tooth replacement, including, but not limited to, dentures, dental implants, bridges, crowns, or corrective procedures such as root canals.
(b)

(c)
The Department of Human Services shall extend Medicaid coverage to adults aged 21 and over covered by the Medicaid program for diagnostic and preventative dental services and restorative dental services, excluding cosmetic services. This coverage is limited to $2,000 per two-year budget period. Recipients must pay for services over the $2,000 limit. No provision in this section shall restrict the department in exercising new options provided by, or to be in compliance with, new federal legislation that further expands eligibility for dental care for adult recipients.
(c)

(d)
The department is responsible for the implementation of, and program design for, a dental care system to reduce the continuing harm and continuing impact on the health care system in West Virginia. The dental health system design shall include oversight, quality assurance measures, case management, and patient outreach activities. The department shall assume responsibility for claims processing in accordance with established fee schedules and financial aspects of the program necessary to receive available federal dollars and to meet federal rules and regulations. The department shall seek authority from the Centers for Medicare and Medicaid Services to implement the provisions of this section.
(d)

(e)
On or before December 1, 2027, the Bureau for Medical Services shall file a report with the Legislative Oversight Commission on Health and Human Resources Accountability and the Joint Committee on Government and Finance analyzing Medicaid expenditures related solely to the dental program for the plan year immediately prior to the passage of this legislation and each plan year until the date of submission of the required report. The report shall include at a minimum an analysis of the enrollees served, the state share of the Medicaid expenditures, and the federal share of expenditures.
(f) On December 1, 2028, the Bureau for Medical Services shall increase dental-related fees by at least 20 percent.

NOTE: The purpose of this bill is to increase Medicaid dental provider reimbursement rates.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.

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