For low-income older adults and people with disabilities, Medicaid provides a lifeline for services that Original Medicare does not cover, including dental benefits. All but one state covers adult dental in Medicaid, and recent analysis shows that the number of states offering extensive dental coverage continues to grow.
However, the Budget Reconciliation Act of 2025 (H.R. 1), which makes significant cuts to Medicaid funding to states, places this coverage at risk and threatens the oral health of 36.2 million adults enrolled in Medicaid.
Given the crucial role that Medicaid plays in providing essential oral health care, it is vital to safeguard and enhance access to this coverage in spite of federal and other fiscal threats.
The Important Role of Oral Health on Overall Health & Wellbeing
Poor oral health, like tooth decay and gum disease, can cause significant pain and impact the ability to eat, speak, and focus. The impact of poor oral health also extends beyond the mouth. Research shows that poor oral health is linked to various chronic conditions, including diabetes, heart disease, and most recently Alzheimer’s and dementia. Poor oral health can also increase the risk of experiencing a stroke and aspiration pneumonia, especially for older adults with chronic conditions and residing in long-term care facilities.
Access to oral health care is particularly important for low-income older adults and people with disabilities who are dually enrolled in Medicare and Medicaid. Data shows that people dually eligible experience higher rates of multiple chronic conditions and mental health impairments than the general Medicare population without Medicaid.
Moreover, older adults from communities of color, who are more likely to be dually eligible compared to the general Medicare population, have higher rates of poor oral health including untreated tooth decay, and missing teeth compared to white older adults. Access to oral health care through Medicaid for dually eligible enrollees, therefore, helps to improve chronic conditions and reduce disparities in oral health and overall health outcomes.
Medicaid Cuts Threaten Access to Oral Health
Under federal law, states have the option but are not required to cover adult dental benefits in their Medicaid programs. Today, all but one state has opted to provide adult dental coverage to some extent.
However, when states experience budget shortfalls, they often cut optional benefits first, with dental coverage being one of the most vulnerable. For example, California eliminated adult dental coverage in 2008, leaving most Medicaid enrollees without access to dental care from 2009 to 2014, except for residents in institutional settings and pregnant women.
While California partially restored dental benefits in 2014 and fully restored them in 2018, the consequences of the elimination continue to reverberate today, serving as a warning of what’s at stake when states cut oral health coverage. Increased state costs, emergency room utilization, and strains on local resources including Community Health Clinics have similarly plagued other states that have cut adult dental benefits.
Even before H.R. 1 cuts go into effect, states are already responding by making cuts to their Medicaid programs. Most recently, states, such as Colorado, North Carolina, and others have proposed cuts to provider reimbursement rates, including dental provider rates.
The Harms of Cutting Oral Health Are Significant
Cutting oral health care would have profound and far-reaching consequences.
It was traumatic for me to lose my teeth at age 46. It was not easy to get used to dentures. It impacts my self-esteem.
Alison, a 54-year-old dually eligible individual living with a disability in Colorado.
Health and Well-being
One of the most immediate harms of cutting oral health coverage is the impact on the health and overall well-being of Medicaid enrollees, who without coverage cannot afford to obtain care.
National data shows that when states cut Medicaid adult dental benefits, enrollees delayed care and increased their use of obtaining treatment in emergency rooms and primary care offices for dental issues that could have been addressed earlier.
This not only placed their health at risk and caused unnecessary pain and suffering, but it also diverted care to settings less equipped to provide quality dental treatment and that are more costly, further straining state budgets.
For older adults and people with disabilities who are more likely to have underlying medical conditions, cuts to oral health care coverage are particularly detrimental. Recent clinical studies show the bidirectional link between oral health and chronic diseases such as dementia, cardiovascular disease and diabetes. Oral disease can increase the risk of developing or worsening these chronic conditions, and these conditions can, in turn, negatively impact oral health.
I’ve got eight teeth in my mouth, and I’ve pulled every one of my own teeth because insurance just don’t cover it, and it should.
Lawrence, a 70-year-old resident of rural South Dakota
Access and Disparities
Cutting oral health coverage would set back the progress that many states have made in increasing access to necessary dental care and addressing existing disparities based on race and other demographic factors.
Similarly, experts warn that Medicaid provider rate cuts could lead to providers discontinuing their participation in Medicaid programs leading to prolonged wait times for care and exacerbating existing access issues.
In my 15-year career in the non-profit sector, I went without dental coverage because my employer did not offer health insurance benefits.
Alison, a 54-year-old dually eligible individual living with a disability in Colorado.
Economic Security
Cuts to oral health have a detrimental impact on the economic security on those with the least resources. Medicaid enrollees have very low incomes. To pay for oral health care means having to forgo other essential needs. Low-Income older adults simply cannot afford dental services without Medicaid coverage.
Research shows the cost barrier to dental care presents with the highest frequency for all older adults, and most acutely for low-income older adults from communities of color. Without Medicaid coverage of dental services, older adults will be forced to go without necessary care, forgo other basic necessities like food, clothing, or basic household items, and take on medical debt. Current data shows that for older adults with medical debt, 48% is attributed to dental care, which will increase if adult dental benefits are cut in Medicaid.
Oral health impacts life in so many ways and it needs to be fully covered for everyone.
Alison, a 54-year-old dually eligible individual living with a disability in Colorado.
Increased Costs to States
Cutting adult dental coverage in Medicaid would have significant and long-term effects on state budgets. Research indicates that reducing dental coverage will limit access to treatment, ultimately worsening overall health. This deterioration in health can lead to increased healthcare costs for states.
For instance, if Colorado were to eliminate adult dental benefits, the state could see its annual health care costs rise by over $47 million. Over a five-year period, this would result in more than $236 million in additional spending for health care, costs that would have been avoided if the state retained coverage of adult dental.
I’ve worked hard in my life, and I paid into it, and I feel I should have those big benefits
Lawrence, a 70-year-old resident of rural South Dakota
Bottom Line: Protecting Oral Health is Essential for Older Adults
H.R. 1 cuts to Medicaid funding to states jeopardizes access to oral health care, which is critical for the overall health and well-being of older adults and people with disabilities. As states face reduced Medicaid funding and strains on budgets, it is imperative for states to maintain Medicaid adult dental benefits to ensure these populations, and all Medicaid enrollees, have access to the oral health care they need to maintain their overall health and quality of life.
Cutting these benefits not only threatens the health of older adults and people with disabilities, these cuts also increase costs to the state putting budgets in a worse financial position. Simply put, older adults and states cannot afford the consequences of reducing Medicaid adult dental benefits.
I did my best to practice good oral hygiene at home, but the gum infection became so bad that my teeth started falling out.
Alison, a 54-year-old dually eligible individual living with a disability in Colorado.
Real Stories: What’s At Stake
Without access to oral health coverage, impacts to quality of life encompasses mental health as well as overall health. For Alison, a 54-year-old dually eligible individual living with a disability in Colorado, Medicaid adult dental benefits provided access to treat oral disease, maintain her mental health and sustain her quality of life. The following is an excerpt from a conversation with Alison about her oral health journey from being uninsured to fully insured with Medicaid adult dental benefits.
“In my 15-year career in the non-profit sector, I went without dental coverage because my employer did not offer health insurance benefits. Without health insurance coverage and with two children, I could not afford paying for routine dental care. I did my best to practice good oral hygiene at home, but the gum infection became so bad that my teeth started falling out. I had to go to the dentist. When the dentist informed me that I had to get all of my teeth pulled, I got a second opinion. At that point, I was able to get Medicaid coverage. When the second dentist informed me that I had to get all of my teeth pulled, I was able to get the gums treated, get dentures, and get adjustments for the dentures with Medicaid. It was traumatic for me to lose my teeth at age 46. It was not easy to get used to dentures. It impacts my self-esteem. But, if I did not have dentures, it would be even worse. I would look completely different, and I would only be able to eat soft foods. Both of these things would be absolutely debilitating to my mental and physical health. Oral health impacts life in so many ways and it needs to be fully covered for everyone.”
Access to dental services is a particular challenge for older adults and disabled people living in rural America even in states that provide Medicaid adult dental benefits. For example, while South Dakota provides enhanced Medicaid adult dental benefits, the majority of the state is designated a dental health care shortage area leaving residents in rural communities particularly vulnerable without access to care. In an interview for The People Say Project, Lawrence, a 70-year-old resident of rural South Dakota described the challenges of not having access to dental services and the indelible impact on his oral health.
“All in all, I can’t say anything bad about Medicaid or Medicare. I know the only thing I’m lacking as far as assistance from Medicaid and Medicare is my vision, my hearing, my teeth, you know. I’ve got eight teeth in my mouth, and I’ve pulled every one of my own teeth because insurance just don’t cover it, and it should. I mean, there’s no two ways around that. Medicare should step up to the plate and take care of that for elderly people, and they don’t, and they should, you know. ‘Cause I’ve worked hard in my life, and I paid into it, and I feel I should have those big benefits, you know. I mean, other insurance companies offer that, and I think Medicare and Medicaid should offer it, and it should be absolutely free. It should be, you know.”
