Medicaid cuts put adult dental care on the chopping block

The big picture: Comprehensive Medicaid dental coverage is associated with better oral health, and better oral health, in turn, is connected to decreased risk of cardiovascular disease, pregnancy complications and other physical health concerns.

• Lack of dental insurance also pushes people to the hospital for treatment, where it's more expensive to provide care.
• "Without coverage, many will delay care or turn to emergency rooms, driving up health care costs and worsening health outcomes," said Melissa Burroughs, director of public policy at CareQuest Institute for Oral Health.

Context: The House of Representatives last month adopted a federal budget resolution that calls on a key committee that governs Medicaid to find at least $880 billion in spending cuts over the next 10 years.

• The spending blueprint doesn't mandate cuts to Medicaid. But the committee would essentially have to make changes to federal funding for the program in order to reach the spending target, likely pushing more program costs onto states.

States have to cover dental services for children enrolled in Medicaid, but they can choose whether and how extensively to cover oral health care for adults.

• CareQuest rated just nine states as having extensive dental benefits in 2023, the most recent year for which data is available.
• That's up from four states in 2020, and at least six states improved their dental coverage in 2024, according to the nonprofit.
• But even with strong benefits, low Medicaid reimbursement rates for dental care make it hard to convince dentists to take the insurance.

Flashback: When finances have been strained in the past, states have decreased or eliminated their adult dental coverage.

• Those decisions have come with measurable consequences: Emergency department visits for dental concerns increased 11% in Massachusetts in the year and a half after the state got rid of comprehensive Medicaid dental benefits in 2010.
• California's elimination of broad Medicaid adult dental coverage in 2009 was associated with an immediate increase in ED visits for non-traumatic dental issues, and an immediate decrease when the state began reintroducing Medicaid dental benefits in 2014, an analysis published Monday in JAMA Network Open found.

Zoom in: The specter of Medicaid cuts has already started to curtail dental access for low-income Americans.

• Community Health and Wellness Center of Greater Torrington in northwest Connecticut ended its dental services last week in anticipation of federal Medicaid changes trickling down to state-level cuts, CEO Joanne Borduas told Axios.
• Dental was its most expensive service line, and the federally qualified health center lost about $350,000 on dental services last year, she said.
• "With the Medicaid cuts, we just would not be able to continue to absorb those kinds of losses," she said.

Community Health and Wellness Center is helping its roughly 1,400 dental patients find oral health care elsewhere, but there are only two practices in the area that take Medicaid, Borduas said.

• The center hopes to bring back dental services in the future.

Between the lines: Fluorinated water, which reduces dental health disparities, is also on the chopping block in many communities.

• HHS Secretary Robert F. Kennedy Jr. has advocated for communities to stop adding fluoride to their water supply, despite there being no evidence that the level of the mineral used by most U.S. cities causes harm.
• Utah last month became the first state to pass a bill that would prohibit localities from fluorinating their water. The bill is currently awaiting the governor's signature.
• The effects of getting rid of fluoride in drinking water would take more time to bear out than Medicaid coverage changes. But in the long run, these two policy changes would exacerbate the oral health crisis, especially for lower-income Americans, CareQuest's Burroughs said.