Medicaid Is Paying for More Dental Care. GOP Cuts Threaten To Reverse the Trend.

Star Quinn moved to Kingsport, Tennessee, in 2023, the same year the state began covering dental costs for about 600,000 low-income adults enrolled in Medicaid.

But when Quinn chipped a tooth and it became infected, she couldn’t find a dentist near her who would accept her government health coverage and was taking new patients.

She went to the emergency room, given painkillers and antibiotics, but was left in excruciating pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old woman with four children who, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said, “because at the end of the day, dental care is health care. »

The federal government has long required states to provide dental coverage to children enrolled in Medicaid, the joint state-federal health program for low-income or disabled people. However, paying for adult dental care is optional for states.

In recent years, several states have chosen to expand the coverage offered by their Medicaid programs, seeking to improve access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a KFF Health News sample of six such states, fewer than one in four adults on Medicaid see a dentist at least once a year.

But under Congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to cut Medicaid spending by more than $900 billion over the next decade. The 10-year expected losses for each state range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits based on their finances, and such massive federal cuts could force some to reduce or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for example, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related emergency room visits, said Amy Lawrence, a spokeswoman for the program.

But under the new law, Tennessee is expected to lose about $7 billion in federal funding over the next decade.

Last year, 38 states and the District of Columbia offered enhanced dental benefits to adult Medicaid beneficiaries, according to the American Dental Association. Most others offer limited or emergency care only. Alabama is the only state that offers no dental coverage to adult beneficiaries.

Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns and dentures, while relaxing annual dollar caps for benefits.

Utilization of dental benefits in states with enhanced benefits is higher than in states offering only limited or emergency coverage, although it remains low overall, according to an ADA report with latest data from December. No more than a third of adult Medicaid beneficiaries visited a dentist in 2022, in any state.

To review the most recent progress, KFF Health News asked a third of states that expanded benefits in the past five years for their most recent data on the percentage of adults on Medicaid who see a dentist at least once a year:

• Maryland — 22% (in 2024)
• Oklahoma — 16% (in 2025)
• Maine — 13% (in 2025)
• New Hampshire — 19% (in 2025)
• Tennessee — 16% (in 2024)
• Virginia — 21% (in 2025)

In comparison, about 50 to 60 percent of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationally, 41% of dentists reported participating in Medicaid in 2024, a share that has remained steady over the past decade despite the expansion of dental benefits in many states, according to the ADA. Many participating dentists, however, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.

Reimbursement rates have not kept up with costs, dissuading dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president of the ADA Health Policy Institute.

Due to the lack of dentists taking Medicaid in Southwest Virginia, Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for treatment — and has to turn many of them away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them on Medicaid. About 3,000 people are on its waiting list, waiting up to a year to be seen.

“It’s sad because now they can afford to see a dentist, but they still don’t have a dental office,” Smith said.

Low-income adults face other barriers to dental care, including lack of transportation, child care or time off work, she said.

Being unable to see a dentist has consequences that go beyond dental pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease and diabetes. It can also make it more difficult to apply for jobs and generally lead a healthy lifestyle.

Robin Mullins, 49, who has been off Medicaid since 2013, said the lack of regular visits to the dentist contributed to the loss of her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives nearly 90 minutes to Smith’s clinic, which is when she can afford to take time off from driving for DoorDash or finding help watching her daughter, who has special needs.

She gets by with partial dentures but is missing her natural teeth, she said. “It’s absolutely horrible because you can’t chew your food properly.”

In New Hampshire, however, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive officer of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, as well as two mobile dental units that travel across the state, he said.

Raffio said Northeast Delta Dental has also spread awareness of the state’s benefits using radio and social media advertisements, among other efforts.

Until 2023, New Hampshire Medicaid only covered dental emergencies.

“Culturally, it’s going to take a while,” he said, “because people are just used to not going to the dentist or not going to the emergency room when they have dental pain.”

Brooks Woodward, dental director of Baltimore-based Chase Brexton Health Care, called the rate of about 1 in 5 adults on Medicaid in Maryland seeing a dentist in 2024 “pretty good,” given that benefits have only been enhanced since 2023.

Woodward said many adults on Medicaid believe you only go to the dentist when you’re in pain. “They just didn’t go to the dentist, and that’s just how they lived their lives,” he said.