Nearly one year after HR 1 became law, states are confronting funding cuts and new work and eligibility requirements that threaten access to dental care under Medicaid — and industry leaders say the full impact has yet to be felt.
HR 1, enacted in July 2025, is expected to lead to a decrease in Medicaid spending by nearly $1 trillion over the next 10 years. The bill has been criticized by many organizations, with many leaders denouncing the bill’s cuts to healthcare.
Michael Curry, the president and CEO of the Massachusetts League of Community Health Centers, warned last year that states could choose to no longer cover dental services under Medicaid because these are optional benefits. Some states have already enacted or begun considering such changes as a way to save money. For example, Colorado implemented a $3,000 annual cap for dental benefits, while Washington, California and Idaho have cut reimbursements rates.
About 23 million adults receive dental coverage through Medicaid, according to the CareQuest Institute for Oral Health.
CareQuest CEO Wade Rakes recently spoke with Becker’s to discuss the impact oral healthcare leaders have already seen from HR 1 nearly a year after its passage, along with what we can expect to see down the line.
Note: Responses were lightly edited for clarity and length.
Question: How have you seen the impact of this bill on dental care play out in various states since its passage?
Wade Rakes: As we looked at the bill passing, we knew there would be impact in the states, and we have begun to see some early action in states where they’re already reducing their benefits. We’ve seen it in the state of Washington, in the state of California and Colorado — which are already cutting provider reimbursement rates — and then in other states, which continue to have legislative sessions and are reviewing their budgets, including Massachusetts and Virginia. They are also looking at ways to address what they see will be a significant deficit in their overall funding as the bill comes into full action in 2027.
Q: What oral health metrics is CareQuest keeping an eye on right now as it tracks the impact of this bill?
WR: The biggest one we can see [is emergency department visits] because we know when you lose coverage that the emergency department utilization sees an uptick, but also we have seen that just the peace of mind that comes from having coverage can have an impact on preventative care. So, it’s not just what we see emerging in the emergency room. You begin to see a decline in visits and engagement across the entire level of general [and] specialty dentistry and care as well. We’re still in the early stages as these are [legislative] sessions that are underway, but we expect to continue to see declines in engagement, and certainly declines in preventive care.
Q: What are the larger implications of these cuts on healthcare, particularly for rural communities where other healthcare providers, such as emergency departments, may also be struggling financially and be unable to meet the increased demand?
WR: We have raised the alarm that we had 1.6 million emergency department visits for dental care [in 2022, which amounts to] $4 billion in costs. Of course, emergency departments are not equipped to treat disease. They can manage pain or infection, but they don’t fix the underlying problems. First, we’ve talked about the need to continue to expand the pipeline, so that there are clinicians to treat in rural communities. Rural communities suffer significantly higher incidences of disease because of access challenges, particularly around specialty care and disease management in oral health. If there is not an emergency department available, or if the hours have changed, that is only going to make what is already an existing crisis in oral health for individuals in rural communities that much harder. What it will do is add pressure to the system that is only going to increase the overall costs for everyone in the system, including those state payers in their programs. It is something we’re tracking, and something that has been a concern of ours. It’s something we’ve brought attention to for a very, very long time.
Q: What can be done in the meantime as the impact of this bill is playing out to ensure patients can still access dental care and receive the best treatment possible?
WR: There are some states that have either reaffirmed a commitment to extended dental benefits for adults, or through this session, maintained that coverage. Even in the past five years, Kansas, Maine, Maryland, Utah and Virginia have all taken actions to extend their programs, and while we are tracking Virginia very closely this session, some states are seeing and hearing that it’s critical that they hold the line here because, as I said, you can save money and spend more when you put cuts, particularly into this benefit.
The most important thing we are saying to people impacted is what we at CareQuest are dedicated to, which is providing evidence-based information to policymakers, and we are delighted to partner with a number of community organizations but really the people who will be impacted by this to ensure they can speak directly with their legislators to make this real and to make this known. Yes, the data we provide explains what happens, but there’s nothing I find more important and more compelling than to ensure and enable the ability for our neighbors, who are going to be the ones who are going to be suffering, to be able to explain what this means for them in their lives. They’re going to miss school, they are going to miss work, they’re going to be in pain, and what we see is that cuts in this space don’t get the outcome if you view it as a budget process only, so we are really committed to reinforcing and ensuring that the care part of healthcare is emphasized in the humanity of the people, not just as budget line or bill language.
Q: How has this bill affected community health centers and other safety net providers?
WR: The funding for community health centers has been consistently supported through many Congresses and many administrations, and the work of the National Association of Community Health Centers, as well as primary care associations and centers themselves, actually resulted in them getting funding in the most recent budget. Certainly, that’s not permanent, and we are going to see compression in other programs. They serve as the backbone of the system for individuals who are under insured or uninsured. So, though they saw their funding supported in many ways, the pressure to the overall system, when you pull hundreds of billions of dollars out of Medicaid, is going to come to their doorsteps, and is going to increase the level of pressure that many of these small tax-exempt, nonprofit organizations are going to be facing.
We announced a partnership with the National Association of Community Health Centers earlier this year to bring great attention to the need for high-quality oral healthcare. They are the largest network of multispecialty practices, so they are a critical part of ensuring there’s access, as well as ensuring that there’s connection between not just your oral health but your overall health. The centers have made their case consistently, but again, because much of the impact of the bill was backloaded — meaning passed in one year, but really the effectuation coming in 2027 — there are a lot of unknowns, but what we do know from history is that this is going to put a tremendous amount of pressure on an already strained system.
Q: Looking ahead, what are you most worried about, and what gives you hope?
WR: I am worried that this could be worse than we expect. I am worried because the system is so different based on where you live that you’re going to see a high level of disparity, so it’s going to be important for us to look at this at the state level, not just at the national aggregate level. I have significant concerns that you’ve raised already around rural health and what it means to the network because once you begin to modify these programs, the delivery system of clinicians, dentists, hygienists, dental therapists — in many cases they leave the network, and even when the systems may get funding back, or even when times may get better, they don’t come back into the system. What it does is it has a long tail of impact on the access to care for individuals in the long term, so what worries me is that it could be worse.
What gives me hope is what I referenced earlier. There are states that are stepping forward and understand how important it is to invest in these programs to ensure they support their community practices, because as you know, many oral health practices are just small businesses in the communities in which they are located. Earlier this month, we had an OPEN Hill Day, which is a program we put in place. We were able to see more than a third of the congressional offices to talk about the importance of oral health. We were welcomed, and this was in a bipartisan way by members and their staff to continue talking about this … We had a record number of attendees from over 30 states, including territories, make their way to Washington, and we have seen policy change in many ways coming forth from that. I’m hopeful that there will continue to be not just coverage of this issue, but action on the part of individuals around the country, with CareQuest really taking the role of ensuring that the data that shows very clearly that we can improve outcomes and improve communities by committing to comprehensive oral health coverage is something we will continue to see illuminated by people and embraced by policymakers. This is very challenging, but as I said, in several states around the country, we are beginning to see signs that the information and the impact is coming through.
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