States save only about 20 to 50 cents for every $1 they cut from Medicaid dental spending, depending on their federal matching rates, according to a study published Oct. 16 in JAMA Health Forum.
The authors analyzed Medicaid fee-for-service dental spending in all 50 states and Washington, D.C., using federal spending data from 2013 to 2024 and enrollment data from 2016 to 2022.
The data does not capture dental spending inside managed care plans, where most adult Medicaid dental services are delivered, so they understate total dental spending. The study is a cross-sectional, state-level analysis of fee-for-service spending, and the authors said adult and pediatric dental spending are combined in the data, limiting state-specific savings estimates.
Idaho, Nebraska and Kansas were excluded because adult dental care there is delivered mainly through managed care.
Here are eight things to know from the study:
- States save about $0.20 to $0.50 for every $1 reduction in dental spending, depending on matching rates.
- The federal share of fee-for-service Medicaid dental spending ranged from 50.4% to 79.4% across states from 2013 to 2024, with a median of 66.1%. In 2024, 16 states received at least 70% of that spending from federal funds, and five received more than 75%.
- West Virginia spent $4.95 million on fee-for-service dental care in 2024, 77.9% of it federally financed. Eliminating adult benefits would cut spending by about $4.1 million but save the state only $0.91 million while forgoing $3.2 million in federal funds, or about $3.50 in federal dollars for every $1 of state savings.
- States with higher federal matching rates were less likely to offer comprehensive adult dental benefits. From 2013 to 2024, a 10-percentage-point increase in a state’s statutory federal matching rate was associated with a 14-percentage-point lower probability that it offered comprehensive adult dental benefits versus all other benefit levels. The authors said the association is observational.
- In 2024, 11 states with federal matching rates of 60% or higher offered emergency-only dental coverage or none at all for adults, including Mississippi and Alabama, where the rates were 73% or higher. The number of states offering comprehensive adult benefits rose from 11 to 35 over a decade.
- Medicaid fee-for-service dental spending grew to more than $6 billion in 2024 from about $4.8 billion in 2013 and remained below 1% of total fee-for-service Medicaid spending. Average dental spending per enrollee rose from $168 in 2016 to $203 in 2022, in 2024 dollars.
- In 2022, per-enrollee dental spending averaged $662 for children, including those covered through the Children’s Health Insurance Program, compared with $171 for adults. The authors said adults accounted for approximately 79% of combined dental spending.
- Citing an American Dental Association analysis, the authors said eliminating adult Medicaid dental benefits could increase U.S. healthcare costs by about $1.9 billion, through greater emergency department use and unmet periodontal treatment needs.
