Star Quinn moved to Kingsport, Tennessee, in 2023, the identical yr the state started protecting dental prices for about 600,000 low-income adults enrolled in Medicaid.
However when Quinn chipped a tooth and it turned contaminated, she couldn’t discover a dentist close to her dwelling who would settle for her authorities well being protection and was taking new sufferers.
She went to an emergency room, receiving painkillers and antibiotics, however she remained in agonizing ache weeks later and paid a dentist $200 to extract the tooth.
Years later, it nonetheless hurts to chew on that aspect, she mentioned, however Quinn — a 34-year-old who has 4 kids and, together with her husband, earns about $30,000 a yr — nonetheless can’t discover a dentist close by.
“It is best to be capable of get dental care,” she mentioned, “as a result of on the finish of the day dental care is well being care.”
The federal authorities has lengthy required states to supply dental protection for youngsters enrolled in Medicaid, the joint state-federal well being program for people who find themselves low-income or disabled. Paying for adults’ dental care, although, is non-compulsory for states.
Lately, a number of states have opted to broaden the protection provided by their Medicaid packages, searching for to spice up entry in recognition of its significance to total well being. To this point, rising grownup dental care is a piece in progress: In a sampling of six of these states by KFF Well being Information, fewer than 1 in 4 adults on Medicaid see a dentist at the least yearly.
However beneath congressional Republicans’ One Massive Lovely Invoice Act, which President Donald Trump signed into legislation final yr, the federal authorities is anticipated to scale back Medicaid spending by greater than $900 billion over the subsequent decade. The anticipated 10-year losses for particular person states vary from about $184 million for Wyoming to about $150 billion for California.
State Medicaid packages sometimes broaden or scale back advantages relying on their funds, and such large federal cuts may power some to shrink or eradicate what they provide, together with dental advantages.
“We are going to lose all of the positive factors we have now made,” mentioned Shillpa Naavaal, a dental coverage researcher at Virginia Commonwealth College in Richmond.
Tennessee’s Medicaid program, as an example, spent almost $64 million on its dental protection in 2024 and noticed a 20% lower in dental-related ER visits, mentioned Amy Lawrence, this system’s spokesperson.
However beneath the brand new legislation, Tennessee is projected to lose about $7 billion in federal funding over the subsequent decade.
As of final yr, 38 states and the District of Columbia provided enhanced dental advantages for grownup Medicaid beneficiaries, in line with the American Dental Affiliation. A lot of the others supply restricted or emergency-only care. Alabama is the one state that gives no dental protection for grownup beneficiaries.
Since 2021, 18 states have enhanced their protection to incorporate checkups, X-rays, fillings, crowns, and dentures, whereas loosening annual greenback caps for advantages.
Use of dental advantages in states with the improved advantages is bigger than in states with solely restricted or emergency protection, although nonetheless low total, in line with an ADA report with the newest knowledge as of December. Not more than a 3rd of grownup Medicaid recipients noticed a dentist in 2022 in any state.
To overview newer progress, KFF Well being Information requested one-third of the states which have expanded their advantages up to now 5 years for his or her most up-to-date knowledge on the share of adults on Medicaid who go to a dentist at the least yearly:
- 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)
Compared, about 50% to 60% of adults with personal dental protection see a dentist at the least yearly, in line with the ADA.
Nationwide, 41% of dentists reported collaborating in Medicaid in 2024, a share that has remained steady over the previous decade regardless of the dental profit expansions in lots of states, the ADA says. Many collaborating dentists, although, restrict the variety of Medicaid enrollees they deal with, and a few is not going to settle for new sufferers on Medicaid.
Reimbursement charges haven’t stored up with prices, deterring dentists from accepting Medicaid, mentioned Marko Vujicic, chief economist and vice chairman on the ADA Well being Coverage Institute.
Due to an absence of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Group Dental Middle in Abingdon sees sufferers who journey greater than two hours for care — and should flip many away, mentioned Elaine Smith, its government director.
The middle’s seven residents handled about 5,000 sufferers final yr, most of them on Medicaid. About 3,000 persons are on its waitlist, ready as much as a yr to be seen.
“It’s unhappy as a result of they’ve the means now to see a dentist, however they nonetheless don’t have a dental dwelling,” Smith mentioned.
Low-income adults face different boundaries to dental care, together with an absence of transportation, little one care, or time without work work, she mentioned.
The shortcoming to see a dentist has penalties broader than tooth ache. Poor dental well being can contribute to a number of different vital well being issues, comparable to coronary heart illness and diabetes. It could additionally make it more durable to do issues like apply for jobs and usually lead a wholesome life.
Robin Mullins, 49, who has been on and off Medicaid since 2013, mentioned an absence of standard dental visits contributed to her shedding her backside enamel. Unable to discover a dentist close to her dwelling in rural Clintwood, Virginia, she drives virtually 90 minutes to Smith’s clinic — that’s, when she will be able to afford to get time away from driving for DoorDash or discover assist watching her daughter, who has particular wants.
She will get by with partial dentures however misses her pure enamel, she mentioned. “It’s completely horrible, as you’ll be able to’t chew your meals correctly.”
In New Hampshire, although, the challenges have extra to do with low demand than a low provide of dentists, mentioned Tom Raffio, chief government of Northeast Delta Dental, which manages the state’s Medicaid dental program. The corporate has added new dentists to its checklist of collaborating suppliers, together with two cell dental models that traverse the state, he mentioned.
Raffio mentioned Northeast Delta Dental additionally has publicized the state advantages utilizing radio promoting and social media, amongst different efforts.
Till 2023, New Hampshire Medicaid lined solely dental emergencies.
“Culturally, it’s going to take some time,” he mentioned, “as individuals simply are used to not going to the dentist, or going to the ER when have dental ache.”
Brooks Woodward, dental director at Baltimore-based Chase Brexton Well being Care, referred to as Maryland’s charge of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “fairly good” contemplating the advantages had been enhanced solely since 2023.
Woodward mentioned many adults on Medicaid imagine that you simply go to a dentist solely whenever you’re in ache. “They’ve all the time simply not gone to the dentist, and that’s simply the way in which they’d it of their life,” he mentioned.