S 1640

Florida Senate - 2026  SB 1640
By Senator Smith
17-01369A-26  20261640__
1A bill to be entitled
2An act relating to the Medicaid dental pilot program
3for persons with disabilities; creating s. 409.9079,
4F.S.; defining the term “persons with disabilities”;
5requiring the Agency for Health Care Administration to
6establish and operate a Medicaid dental pilot program
7in a specified region to provide enhanced dental
8services to persons with disabilities; specifying
9eligibility for participation in the pilot program;
10specifying dental services covered by the pilot
11program; providing construction; requiring the agency
12to reimburse dental providers under the pilot program
13at a specified rate; providing for the delivery of
14services under the pilot program through at least two
15licensed dental managed care organizations meeting
16certain criteria; requiring the agency to submit any
17necessary state plan amendments or federal waiver
18applications for federal approval; requiring the
19agency to collect certain data on the pilot program;
20requiring the agency to submit a report on the pilot
21program to the Governor and the Legislature by a
22specified date; providing for expiration of the pilot
23program; providing an effective date.
24
25Be It Enacted by the Legislature of the State of Florida:
26
27Section 1. Section 409.9079, Florida Statutes, is created
28to read:
29409.9079 Medicaid dental pilot program for persons with
30disabilities in Region E.—
31(1) DEFINITION.—As used in this section, the term “persons
32with disabilities” means Medicaid-eligible individuals who:
33(a) Receive Supplemental Security Income (SSI) on the basis
34of disability;
35(b) Are enrolled in a home and community-based services
36(HCBS) waiver program under s. 1915(c) of the Social Security
37Act; or
38(c) Meet federal disability criteria under 42 U.S.C. s.
391382c(a)(3), as determined by the Social Security Administration
40or the state Medicaid program.
41(2) PILOT PROGRAM ESTABLISHED.—The agency shall establish
42and operate a 3-year Medicaid dental pilot program in Region E
43of the Statewide Medicaid Managed Care program to provide
44enhanced dental services to persons with disabilities.
45(3) ELIGIBILITY.—Participation in the pilot program is
46limited to persons with disabilities who reside in Region E and
47are enrolled in the Medicaid program.
48(4) COVERED SERVICES.—
49(a)Dental services provided under the pilot program must
50include all of the following:
511. Routine diagnostic and preventive care, including
52examinations, cleanings, and radiographs.
532. Basic dental services, including fillings and
54extractions.
553. Major dental services, including root canals, crowns,
56dentures, and other dental prostheses.
574. Emergency dental services.
585. Any additional dental services the agency determines are
59necessary to promote oral health and prevent disease.
60(b)Services provided under this subsection supplement, and
61do not replace, dental benefits available under ss. 409.906 and
62409.973.
63(5) REIMBURSEMENT.—The agency shall reimburse providers of
64dental services under the pilot program at a rate equivalent to
6580 percent of the 50th percentile of the 2024 Usual, Customary,
66and Reasonable fees, as determined by the American Dental
67Association or a comparable benchmark approved by the agency.
68(6) MANAGED CARE PARTICIPATION.—The pilot program must be
69delivered through at least two licensed dental managed care
70organizations that meet agency standards and have demonstrated
71experience in providing dental services to persons with
72disabilities.
73(7) FEDERAL APPROVAL.—The agency shall submit for federal
74approval any Medicaid state plan amendments or federal waiver
75applications necessary to implement the pilot program.
76(8) EVALUATION; REPORT.—
77(a)The agency shall collect pilot program data on all of
78the following:
791. Access to dental care.
802. Utilization of services.
813. Reimbursement expenditures.
824. Oral health outcomes for participants.
83(b)By January 1, 2029, the agency shall submit a report to
84the Governor, the President of the Senate, and the Speaker of
85the House of Representatives evaluating the effectiveness of the
86pilot program and recommending whether it should be expanded
87statewide.
88(9) EXPIRATION.—This section expires June 30, 2029.
89Section 2. This act shall take effect July 1, 2026.