Low Medicaid reimbursements are putting dentists in a tight financial position, placing many providers at a crossroads that could deepen the country’s dental care accessibility challenges.
Only 12 states have a reimbursement rate of 80% or more for children Medicaid services, while only eight states have a reimbursement rate of 80% or more for adult Medicaid services, according to 2024 data from the American Dental Association.
Thirteen states offer reimbursement for children Medicaid services at a rate of 60% or lower, while 16 states offer reimbursement for adult services at a rate of 60% or lower. Several states offer no reimbursement for adult Medicaid services.
These challenges are compounded by federal budget cuts that are expected to create a turbulent situation for both providers and patients. Experts have already begun to sound the alarm on what these cuts could mean for dentistry.
Michael Curry, the president and CEO of the Massachusetts League of Community Health Centers recently warned that states could choose to no longer cover adult dental services under Medicaid because these are optional benefits.
ADHA President Lancette VanGuilder said there are several provisions of the bill that decrease federal support for Medicaid, including new work requirements and restrictions on state financing. She warned that the reduction of Medicaid dental benefits could lead to increased rates of untreated oral disease, a greater strain on emergency departments and other long-term health and economic consequences.
“These changes may force states to reassess Medicaid budgets, prioritizing mandatory benefits over optional services like adult dental care,” her statement said. “We urge lawmakers to consider the full public health implications of changes to Medicaid policy and to protect oral health access as an essential component of overall healthcare.”
U.S. Rep Jennifer McClellan recently visited a nonprofit dental clinic in Virginia to discuss the impact of Medicaid cuts on patient care. Ms. McClellan said she is co-sponsoring legislation to reverse the Medicaid cuts, and that she would be taking stories from her visit back to legislators to show the impact of the cuts.
These cuts, if not reversed, could be disastrous to states already facing budget shortfalls. For example, Colorado Gov. Jared Polis issued in September Executive Order D2025-014 to cut Medicaid funding to help fill the state’s $750 million budget deficit. Among the cuts is a $2,500,000 cut to dental rates and a rollback of the state’s 1.6% reimbursement rate increase.
Gov. Polis reportedly told lawmakers during a budget meeting that the cuts were “just the tip of the iceberg.”
Some providers are not willing to stick around as the situation grows more unnerving. Even in some states that have boosted rates in recent years, the increases are still not enough to justify network participation.
Low reimbursements under Maine’s Medicaid program have forced dentists to limit the number of MaineCare patients they treat, causing children to wait several months for dental care. The Maine Dental Association has estimated that there are thousands of children in the state currently waiting for dental treatment.
Carson Cruise, DMD — the owner of Pediatric Dentistry of Florence, Ala., and the only board-certified pediatric dentist in the area who still accepts Medicaid — recently told Stateline that he is considering no longer accepting Medicaid because it has led to financial losses at his practice.
Although it is unclear how the new federal budget will affect state Medicaid programs, Dr. Cruise said any further cuts would likely force him to stop participating in the program.
Corey Anderson, DDS, of Bridgeport, W.V., told Becker’s that Medicaid rates ultimately reflect the priorities of the state and federal governments.
“If our democratically elected leaders decide that more providers are needed to provide services to more patients, then I suggest increasing reimbursements and reducing administrative hassles. If fewer providers are needed, then decrease pay and increase administrative hassles,” he said. “My sense is that there will always be more demand for services for Medicaid patients than will regularly be provided.”
