What's happening
This bill requires Medicaid and state health programs to spend at least 80% of dental funds on patient care, limiting administrative costs to 20%.
Why it matters
Prioritizes patient care by mandating that at least 80% of dental funding in Medicaid and related state health programs goes directly to providing dental services, reducing the risk that funds are diverted to non-patient expenses.
Imposes a strict cap—no more than 20%—on administrative and overhead spending, which could encourage efficiency among managed care organizations and approved providers.
Requires providers to return any unspent patient care funds (if the 80% threshold is not met) to the state, creating financial accountability and discouraging under-utilization of state dental funds.
Mandates clear annual reporting and certification of dental fund allocations, which increases transparency and gives the state tools to monitor compliance and enforce the new spending requirements.
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Who cares
Headline styles
Fund Dental Care Access
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 14
No co-sponsors yet.
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Require Medicaid Dental Spending
In Assembly Committee · Health · Sponsor Inez E. Dickens
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2802
2019-2020 Regular Sessions
IN SENATE
January 29, 2019
Introduced by Sen. COMRIE -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the public health law and the social services law, in relation to allocating monies for dental health services in the medicaid managed care program, the child health insurance program, and the family health plus program
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 2511 of the public health law is amended by adding a new subdivision 22 to read as follows:
22. Every approved organization that provides coverage for any dental service shall spend not less than eighty percent of the capitation or other state funds paid to the approved organization for dental services, whether as a premium or in any other form either directly or indirectly, for the provision of dental services to patients by licensed dentists. In the event the approved organization spends less than eighty percent of the capitation or other state funds paid to it for dental services, whether as a premium or in any other form either directly or indirectly, for the provision of dental services, the difference shall be returned to the department. In no event shall more than twenty percent of the capitation or other state funds paid to the approved organization for dental services, whether as a premium or in any other form either directly or indirectly, be spent by any approved organization on administrative services in lieu of dental services for patients. The department shall provide an approved organization with a certification letter indicating the amount of capitation or other state funds paid for dental services, whether as a premium or in any other form either directly or indirectly, during each year pursuant to this section.
§ 2. Section 364-j of the social services law is amended by adding a new subdivision 34 to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06500-01-9
S. 2802 2
34. Every managed care provider and managed care program that provides coverage for any dental service shall spend not less than eighty percent of the capitation or other state funds paid to the managed care provider or managed care program for dental services, whether as a premium or in any other form either directly or indirectly, for the provision of dental services to patients by licensed dentists. In the event the managed care provider or managed care program spends less than eighty percent of the capitation or other state funds paid to it for dental services, whether as a premium or in any other form either directly or indirectly, for the provision of dental services, the difference shall be returned to the department. In no event shall more than twenty percent of the capitation or other state funds paid to the managed care provider or managed care program for dental services, whether as a premium or in any other form either directly or indirectly, be spent by any managed care provider or managed care program on administrative services in lieu of dental services for patients. The department shall provide a managed care provider and managed care program with a certification letter indicating the amount of capitation or other state funds paid for dental services, whether as a premium or in any other form either directly or indirectly, during each year pursuant to this section.
§ 3. This act shall take effect January 1, 2020, provided, however, that the amendments to section 364-j of the social services law made by section two of this act shall not affect the repeal of such section and shall be deemed repealed therewith.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law and the social services law, in relation to allocating monies for dental health services in the medicaid managed care program, the child health insurance program, and the family health plus program
Purpose or general idea of bill
Requires that eighty percent of monies for dental services under the Medicaid Managed Care Program, the State Child Health Insurance Program (SCHIP), and the Family Health Plus Program be sent on the actual provision of dental services to patients and that no more than twenty percent be spent on administrative costs.
Summary of specific provisions
Bill Section 1 would amend section 2511 of the Public Health Law to require that authorized entities under the state Child Health Insurance (SCHIP) spend not more than twenty percent of the monies allocated towards dental services on administrative costs, with at least eighty percent being spent on actual dental care for patients. Bill Section 2 would amend section 364-j of the Social Services Law to require that authorized entities under the Medicaid Managed care program spend not more that twenty percent of the monies allocated towards dental services on administrative costs, with art least eighty percent being spent on actual dental care for patients. Bill Section 3 would amend section 369-ee of the Social Services Law to require that authorized entities under the Family Health Plus program spend not more than twenty percent of the monies allocated towards dental services on administrative costs, which at least eighty percent being spent on actual dental care for patients. Bill Section 4 would provide that the law take effect January 1, 2020, provisions that apply to all of section 364-j of the Social Services Law.
Justification
It is important to keep track of the monies spent on dental services in the three main government programs serving those who cannot afford dental care on their own- the State Child Health Insurance Plan (SCHIP), Medicaid managed care, and Family Health Plus. Currently, there are no checks on how monies allocated for dental services are spent, with much of that money being wasted on excessive administrative costs that provide no tangible benefits to Patients. This bill, similar to laws that have worked in. New Jersey and Florida, requires that dental monies be allocated primarily - at least 80% - to prevention of dental services to patients.
Not more than 20% can be allocated to administrative coats. This bill will improve the delivery of dental care to less affluent populations and will eliminate wasteful, inefficient spending on administrative costs, ensuring that New York is getting the most out of the, money it is allocating to dental care in the three major government programs that fund such dental care.
Prior legislative history
S6247 COMRIE No Same as
Fiscal implications
None. The bill does not raise costs, but reallocates existing monies more efficiently.
Effective date
The bill takes effect January 1, 2020, provided that section 2 of the bill is subject to the existing repeal provisions that apply to all section 364-j of the Social Services Law
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.