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 could not find a dentist near her home who would accept her government health coverage and was taking new patients.
She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing 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 who has four children and, 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 offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, though, is optional for states.
In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by KFF Health News, fewer than 1 in 4 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 reduce Medicaid spending by more than $900 billion over the next decade. The expected 10-year losses for individual states range from about $184 million for Wyoming to about $150 billion for California.
State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive federal cuts could force some to shrink 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 instance, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.
But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.
As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.
Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.
Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to an ADA report with the latest data as of December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.
To review more recent progress, KFF Health News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit 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% of adults with private dental coverage see a dentist at least once a year, according to the ADA.
Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite the dental benefit expansions in many states, the ADA says. Many participating dentists, though, 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, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.
Because of a lack of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many 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 waitlist, waiting up to a year to be seen.
“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.
Low-income adults face other barriers to dental care, including a lack of transportation, child care, or time off work, she said.
The inability to see a dentist has consequences broader than tooth 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 harder to do things like apply for jobs and generally lead a healthy life.
Robin Mullins, 49, who has been off and on Medicaid since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.
She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”
In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.
Raffio said Northeast Delta Dental also has publicized the state benefits using radio advertising and social media, among other efforts.
Until 2023, New Hampshire Medicaid covered only dental emergencies.
“Culturally, it’s going to take a while,” he said, “as people just are used to not going to the dentist, or going to the ER when have dental pain.”
Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.
Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” he said.
Interesting this article published in Oregon did not mention Oregon. Oregon is an outlier for it does not, by in large, pay dental Medicaid (OHP) providers fee for service except for specialty care on referral mainly from capitated primary care dentists. Theoretically in Oregon, every OHP recipient has access to dental care with the priority being diagnosis and urgent/emergent care first, then preventative care, and then routine care through a contract with the CCO through what is called a dental subcontractor (DCO) of which there 4, , Advantage Dental, Capitol Dental, ODS Community Dental Willamette Dental, and just over $100,000 are on open card through the OHA. Advantage and Capitol have about 60-70% of the lives.
Secondly, I have commented many times about "one cannot drill their way out of an infectious disease" called caries of which a cavity is a symptom. This disease is passed usually from the birth person to child in the first 6 months of the child's life. Dentistry can now predict within over 90% accuracy which child will be at risk for cavities. It also known that 25% of OHP children with get a cavity and half of those, will end up sedated. We also now have medicines that if used cannot only prevent the infection that causes the cavity, but also stop it if a cavity shows up with up to 95% success rate if used appropriately.
There is a reason why most states cannot get dentists to participate for most all of them, even if the state contracts the Medicaid program out, pay discounted fee for service. Caries is a progressive disease that manifests it's symptoms differently at every age even if restored with potential tooth loss and finally the patient being made edentulous and dentally disabled. Also the dental preventative method is similar to medicine, change your behavior to get better health outcomes, exercise, eat right, don't smoke or drink alcohol, go to the doctor regularly to catch things early so you can change your behavior etc. Same goes for dental, brush, floss regularly, eat right, use fluoride and go to the dentist regularly. What if one suffers from ACE and childhood trauma and other maladies and for whatever reason cannot change their behavior? So low reimbursement, a disease that is progressive if not controlled with behavior change, suffering from DEI and not accepted into the dominant culture which Medicaid recipients can suffer from, results in lack of access which this article describes very well.
Oregon's issue is similar for it's actuaries calculate dental rates using fee for service which in essence results in low reimbursement and stresses the providers to emphasize more expensive work done rather that procedures that produce health and less work needed to keep the rates up. So in essence Oregon has a bastardized fee for service dental system that emphasizes work rather than health outcomes. An example of this is all the referrals for pediatric care done fee for service with sedation and/or surgery/hospital care. This is breaking the bank so to speak in many areas and putting children's developing brains at risk for learning disabilities. One dental group I know of, if a child is 1-5 years of age and has a cavitated lesion they are automatically sedated to have the cavities treated. Studies show that if a child is at risk and has a cavity filled, they will have a great chance of needing another one with 12 months. My wife was a surgical in hospital dental assistant for a pediatric dentist and her experience if a child was treated for decay in the OR they would be back the next year again and usually for the third time as well.
Everyone is seems to me, suffers from inherent bias thinking they know how dentistry is supposed to work, either blame the dental profession for not participating for either not caring about people and being greedy and play the blame game rather than ask why dental does not work on a population whose dental disease is out of control, for whatever reason is unable to change their behavior, have manifestations of the disease that are too expensive to restore for the money needed. This brings up the last issue that even Oregon still suffers from, namely a system that is designed to fix problems, the bigger the problem, the more expensive the fix. The entire system sits around in their little health care factory, offices, waiting for people to show up, the bigger the problem the bigger the cost, and the biggest little factory is called a hospital. End of heart disease is a ventricular assist device (VAD) while the patient waits for a transplant. In dentistry the end of disease solution is called an implant and implant crown which can cost $5000 each unless a sinus lift is needed which adds another $10,000 per sinus.
I call the current dental paradigm the surgical/restorative, fixit paradigm where our inherent bias which clouds our thinking. Einstein's definition of insanity was "doing the same thing over and over expecting different results."
Respectfully in better care, better health at a better cost
Mike Shirtcliff DMD