The future of dental care for millions of Americans is at stake as a new law threatens to unravel recent progress. Medicaid's expanded dental coverage, which has improved access to oral health for low-income adults, is now in jeopardy due to significant federal cuts.
In 2023, Star Quinn, a 34-year-old mother of four from Tennessee, experienced firsthand the challenges that lie ahead. When she chipped a tooth and it became infected, she struggled to find a dentist who accepted her Medicaid coverage and was taking new patients. This is a common struggle for many low-income adults across the country.
The federal government has long mandated dental coverage for children in Medicaid, but paying for adult dental care has been optional for states. In recent years, several states have expanded Medicaid dental benefits, recognizing the importance of oral health to overall well-being. However, the One Big Beautiful Bill Act, signed into law by President Trump, threatens to reverse this trend.
The law is expected to reduce Medicaid spending by over $900 billion over the next decade, with individual states facing significant financial losses. This could force some states to reduce or eliminate dental benefits, impacting millions of low-income adults who rely on Medicaid for their oral health care.
Shillpa Naavaal, a dental policy researcher, warns that these cuts will erase all the gains made in recent years. States like Tennessee, which spent nearly $64 million on dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, could lose billions in federal funding.
Currently, 38 states and the District of Columbia offer enhanced dental benefits for adult Medicaid beneficiaries, but many others provide limited or emergency-only care. Alabama is the only state with no dental coverage for adult beneficiaries.
Since 2021, 18 states have expanded their coverage to include checkups, X-rays, fillings, crowns, and dentures, while lifting annual dollar caps for benefits. However, the use of dental benefits remains low overall, with no more than a third of adult Medicaid recipients seeing a dentist in 2022.
KFF Health News surveyed one-third of the states that have expanded their benefits in the past five years, finding that the percentage of adults on Medicaid who visit a dentist at least once a year varies widely. Maryland leads with 22%, while Maine has the lowest rate at 13%.
Despite these efforts, nationwide, only 41% of dentists reported participating in Medicaid in 2024, and many limit the number of Medicaid enrollees they treat. Reimbursement rates that fail to keep up with costs further discourage dentists from accepting Medicaid.
In southwestern Virginia, the Appalachian Highlands Community Dental Center struggles to meet the needs of its patients due to a lack of participating dentists. Many patients must travel over two hours for care, and the center must turn many away.
Low-income adults face additional barriers to dental care, including transportation issues, childcare challenges, and time constraints at work. These obstacles can lead to severe consequences, such as heart disease and diabetes, as well as difficulties in applying for jobs and leading a healthy life.
Robin Mullins, who has been on and off Medicaid since 2013, lost her bottom teeth due to a lack of regular dental visits. She drives almost 90 minutes to the Appalachian Highlands Community Dental Center, but even then, she must balance her time between driving for DoorDash and finding childcare for her daughter, who has special needs.
In New Hampshire, the challenges are more related to low demand than a low supply of dentists. The state has added new dentists to its list of participating providers and introduced mobile dental units, along with publicizing the state benefits using radio advertising and social media.
Tom Raffio, chief executive of Northeast Delta Dental, acknowledges that changing cultural attitudes about dental care will take time. Many adults on Medicaid believe that you go to a dentist only when you're in pain, and breaking these ingrained habits will require sustained effort.
Despite these challenges, some states have made significant progress in expanding dental benefits. Maryland's rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 is considered 'pretty good' by Brooks Woodward, dental director at Chase Brexton Health Care, given that the benefits were enhanced only in 2023.
KFF Health News, a national newsroom producing in-depth journalism about health issues, highlights the importance of continued efforts to expand dental care for all Americans. As the future of Medicaid dental coverage hangs in the balance, the need for accessible, affordable, and comprehensive oral health care has never been more critical.
