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ADA Health Policy Institute

Dental Benefits and Medicaid

Did my state expand Medicaid eligibility, and what does that mean for my dental practice?

As of November 2018, 37 states including the District of Columbia expanded Medicaid eligibility. Of those states, 25 states including the District of Columbia provide at least limited dental benefits for adults (North Dakota did not offer dental benefits to the Medicaid expansion population). Demand for Medicaid dental services among children and adults is likely to increase moving forward, regardless of Medicaid expansion. The growth in demand depends on the level of adult dental benefits covered by each state and the number of uninsured individuals that qualify for Medicaid moving forward.

Source: The Henry J. Kaiser Family Foundation. Current Status of State Medicaid Expansion Decisions. State Health Facts. As of November 7, 2018.

Center for Health Care Strategies. Medicaid Adult Dental Benefits: An Overview. January 2018. Available from: https://www.chcs.org/media/Adult-Oral-Health-Fact-Sheet_011618.pdf.

 

What share of U.S. children and adults have dental benefits?

Dental benefits coverage varies by age. For children ages 2-18, 51.3 percent have private dental benefits, 38.5 percent of dental benefits through Medicaid or the Children’s Health Insurance Program (CHIP), and 10.3 percent do not have dental benefits. For adults ages 19-64, 59.0 percent have private dental benefits, 7.4 percent have dental benefits through Medicaid, and 33.6 percent do not have dental benefits. 

Source: Dental Benefits Coverage in the U.S. (Health Policy Institute Infographic).

 

Does my state cover dental services for adult Medicaid enrollees?

Adult dental benefits are an optional benefit under Medicaid. As of January 2018, 34 states including the District of Columbia provide at least limited dental benefits for adults beyond emergency services. However, in some states, adult dental services are covered through managed care organizations, even though the state Medicaid program does not traditionally provide adult dental benefits.

Source: Center for Health Care Strategies. Medicaid Adult Dental Benefits: An Overview. January 2018. Available from: https://www.chcs.org/media/Adult-Oral-Health-Fact-Sheet_011618.pdf.

 

How does dental care utilization among Medicaid enrollees compare to dental care utilization among commercially insured individuals?

In general, dental care utilization is higher among individuals with private dental benefits compared to individuals with Medicaid dental benefits. However, dental utilization among Medicaid-enrolled children has been increasing over the past decade. In terms of dental expenditures, the share of financing between private and public benefits remained stable as of 2016.

Source: Dental Care Utilization in the U.S. (Health Policy Institute Infographic).

U.S. Dental Expenditures: 2017 Update (Health Policy Institute Research Brief).

 

How many dentists accept Medicaid?

As of 2015, approximately 38 percent of dentists in the U.S. accept Medicaid or the Children’s Health Insurance Program (CHIP). Medicaid acceptance varies by dentist gender, age, specialty, and the state in which they practice.

Source: Dentist Participation in Medicaid or CHIP (Health Policy Institute Infographic).

Medicaid Fee-for-Service (FFS) Reimbursement and Provider Participation for Dentists and Physicians in Every State (Health Policy Institute Infographic).

 

How many Medicaid patients have access to Medicaid dentists?

The Health Policy Institute has developed a tool for measuring access to dental care using geo-analytics for each state and the District of Columbia. Results report the percentage of publicly insured children living within a 15-minute travel time to at least one Medicaid/CHIP dentist per 2,000 publicly insured children as well as the percentage of overall population living within a 15-minute travel time to at least one dentist per 5,000 population. Data are as of 2015.

Source: Geographic Access to Dental Care (Health Policy Institute State Fact Sheets).