Oral healthcare leaders are working closely with policymakers to protect Medicaid coverage and community water fluoridation in their states after recent updates at the federal level.
Matthew Steele, the director of state and local advocacy, recently joined the Becker’s Dental + DSO Review Podcast to discuss these issues.
Editor’s note: These responses were lightly edited for clarity and length.
Question: What are some of the biggest issues you’re following in the dental industry right now?
Matt Steele: There are two major ones. The first, and probably to no one’s surprise, is Medicaid, with the passage of H.R. 1 or the One Big, Beautiful Bill in Congress. Recently, several state houses have been responding or beginning to plan how they’re going to respond in 2026 to the sweeping Medicaid cuts. The Congressional Budget Office is projecting that these changes could leave about 10 million people uninsured over the next decade. So, the cuts are going deep, and usually in these conversations, from a policy perspective at the state level, on the chopping block first when it comes to Medicaid is often oral health. It’s become front and center for us, and we’re in a little bit of protection mode to make sure these benefits are still available for the most vulnerable parts of our society.
In addition to that, we’re also focusing heavily on fluoride. To no surprise, even prior to President [Donald] Trump getting elected to office, fluoride was a conversation with RFK Jr. in the race, and has kind of been an exponentially increasing issue of attention within media and local policy decisions for a few years now, but in this last legislative session cycle it became front and center. We had [several] states introduce legislation around fluoride this year. Twenty-two states were trying to restrict fluoride. Seven were trying to protect it in their water systems, in some way, shape or form. So clearly, state houses are really honing in on this, and it’s something we’re planning to engage on, seeing that fluoride is often a first line of defense for oral healthcare.
Q: What does protection mode look like for your organization as of right now?
MS: Right now, it’s looking like connecting with different oral healthcare stakeholder groups and networks in states where we feel like the cuts are going to be most severe. We’re having conversations with them to develop advocacy plans and strategies to best protect the possibility of cuts in those states when it comes to the next session cycle. We’re hoping these conversations can develop a plan that will result in the essential nature of this care being maintained for not just the next cycle but years to come. There’s been a lot of data that’s come out recently showcasing in some states where cuts have happened before, how detrimental they were to those who needed the oral healthcare the most. For instance, in Illinois, cutting adult dental benefits in 2012 led to a 128% spike in hospital admissions for dental issues. In California, there was a rollback in 2009 that cost about 4,500 jobs and about $500 million in lost economic activity. So we’re trying to prevent that specifically from happening again within those states, but also more broadly as they consider their budgets moving forward.
Q: What do you think sparked the discussions and skepticism around fluoride?
MS: I think part of what sparked the discussions was just higher profile policy leaders within our country beginning to raise their own awareness about community water and the role it plays in health in general, and we’re hoping we can keep the conversation going. It’s not that we don’t mind the conversation, but we just want the conversation to be rooted in the data that shows the benefit of safe levels of community water fluoridation, but also kind of peels back the curtain on some of the drawbacks to taking those safe levels out of our public water systems. One example I’ll just mention really quickly — In Calgary, Canada, where they removed community water fluoridation, the antibiotic use for kids’ dental infections rose 700% after fluoride was removed. And in Juneau, Alaska, where they followed the same pattern, cavity treatment costs for children went up nearly nine fold. Now, both of those places have reinstated safe levels of community water fluoridation after removing it because the health consequences were so severe. We’re hoping to avoid that as awareness continues to be raised on these issues from public health leaders at a national level and at a local level.
Q: What are you most excited about when it comes to dentistry right now, and what makes you nervous?
MS: I’m excited on one end from some of the proactive policy responses I’m seeing in these two areas. Some of those responses at the state level have been very encouraging. One example I’ll just mention off the top of my head is in Connecticut. Of all the bills introduced this past legislative session cycle, there were a few states that introduced legislation to protect community water fluoridation. Connecticut was one of them, and it was the oral healthcare network within that state that helped spearhead a bill to protect safe levels of community water fluoridation within the state, and really insulating that from any federal or national activity. I’m excited to see local oral healthcare coalitions partnering with their policymakers to protect these data-driven and science-backed approaches to oral healthcare.
We’re carefully watching what happens on Medicaid. I think with the recent passage of H.R. 1, there are a lot of policymakers who still are reading through all of the implications, understanding what that means for their own states and are kind of in the early gestation phases of what it will mean for their budgets coming into 2026 and 2027 with states that are doing budgets on a biannual cycle. We’re really watching that closely, watching how they’re engaging publicly about the topic and seeking to really insert ourselves into those conversations early so we can make sure oral healthcare and preserving it for our most vulnerable populations is at the front of their mind.
