Rural populations experience poorer oral health care access, lower utilization, and worse outcomes compared with their urban and suburban counterparts. An estimated 34% of rural residents lack dental insurance coverage, and 40% have not visited the dentist in more than one year. We also know oral health is deeply connected to overall health and well-being, and improved access to dental care is associated with reduced disease burden and lower costs for chronic conditions that disproportionately affect rural communities.
In response, states are looking to strengthen oral health systems in rural communities with support from a new federal initiative: the Rural Health Transformation Program (RHTP).
RHTP will make $50 billion in federal grants available to states — $10 billion per federal fiscal year from 2026 through 2030. Fifty percent of the funds will be allocated equally among the states, while the remaining 50% “will be allocated by the US Centers for Medicare & Medicaid Services based on a variety of factors.” All 50 states applied for and were approved to receive RHTP funding, with totals ranging from $281 million (Texas) to $147 million (New Jersey). CMS’s Office of Rural Health Transformation will oversee the RHTP and provide monitoring and technical assistance to states throughout the program’s five years.
Many state RHTP applications reflected growing recognition of these rural oral health needs, with several proposals incorporating oral health trends and innovative strategies to expand access, strengthen the workforce, and integrate dental care into broader rural health systems. While these initiatives are not guaranteed to be implemented exactly as proposed, they present meaningful opportunities for oral health advocates to engage with states and help ensure that oral health investments are fully leveraged to address persistent rural access gaps.
Oral Health Trends We’re Seeing Across States
Across state applications, several clear and recurring themes emerged around how states propose to leverage RHTP funding to strengthen oral health access in rural communities:
Workforce Development and Scope-of-Practice Expansion: Many states emphasized strengthening the rural dental workforce through training pipelines, recruitment and retention strategies, and scope-of-practice expansions — particularly for dental hygienists and allied providers — to address persistent provider shortages and improve access to care.
Mobile, Teledentistry, and Remote Access Models: States proposed expanding mobile, portable, and teledentistry models delivered through schools and community settings to bring preventive and diagnostic dental services directly to rural residents.
Facility-Based Expansion and Specialized Dental Services: Several states proposed upgrading facilities or establishing specialized dental centers, including integrated and special care clinics, to better serve patients with complex, high-need, or disability-related dental conditions.
Technology Adoption, Efficiency, and Interoperability: States prioritized investments in dental health IT, interoperability, and teledentistry tools to improve care coordination, efficiency, and integration across medical, behavioral, and dental systems.
Community Integration and Expanded Access Points: Many states highlighted community-embedded dental care models — such as school-based clinics and multidisciplinary teams — to reduce access barriers, support prevention, and integrate dental services with broader community health care.
The Top Five: State Proposals That Stand Out
In addition to these overall trends, five states included particularly promising oral health proposals:
Tennessee proposes up to $75 million to extend and expand its existing rural dental workforce pilot through FY 2030. The initiative will recruit clinicians to rural areas, add and upgrade dental suites, and incentivize preventive and restorative services. The proposal also includes extending value-based payment (VBP) principles into existing Patient-Centered Dental Home models, creating opportunities to link reimbursement to outcomes and better integrate oral health.
The state also establishes oral health–specific metric targets, such as the number of oral health clinicians placed (25) and new dental suites established (15). These explicit, actionable, time-bound goals create momentum while underscoring Tennessee’s commitment to improving access to critical services.
Wisconsin plans to award Dental Technology Grants to expand rural Medicaid access to dental services and increase provider throughput. These grants will incentivize Medicaid participation by rural dental providers, modernize clinical technologies, and expand mobile and telehealth access. Wisconsin’s plan also emphasizes integrating dental services into multidisciplinary, team-based care models in rural communities.
The state also plans pilots and a Medicaid state plan amendment to support dental prevention and care navigation by community health workers in rural areas. Additionally, grants will support care coordination efforts and IT upgrades in tribal clinics.
The state proposes interoperability infrastructure investments specifically for dental providers and plans to use dental-inclusive Wisconsin Collaborative for Healthcare Quality (WCHQ) data to identify gaps, track outcomes, and coordinate care across organizations.
Alaska proposes expanding its Dental Health Aide Therapist (DHAT) program, including investments in recruitment, retention, and training. The state also plans to include preventive, school-based health center (SBHC) and DHAT dental services in alternative payment model (APM) reimbursement designs.
Alaska’s plans further include investments in interoperability and health information exchange (HIE) connectivity for dental providers, technical assistance for oral health quality reporting, and maternal–child and school wellness integration efforts that include oral–systemic health education.
Maine’s RHTP plans include expanding the number of SBHCs with dental services; contracting for a teledentistry network to connect children to ongoing dental care through schools, childcare, and other community settings; funding mobile units that include oral health services; and making interoperability and technology investments targeted specifically at dental providers.
The state also plans to design multipayer APMs that include dental reimbursement.
Connecticut will use RHTP funds to deploy four mobile dental vans. The state also plans to onboard rural providers — including dental providers — to its HIE and invest in telehealth and IT capacity to improve care coordination inclusive of dental care.
Connecticut further intends to include dental care in VBP model design alongside primary, maternal, and behavioral health services.
Andrea Clark, MS
Caroline Le
CareQuest Institute applauds the integration of oral health into state plans to strengthen rural health sustainability and improve access to care. These grants represent powerful opportunities to advance the Institute’s goals of increasing the adoption of integrated, whole-person care inclusive of oral health and expanding access to better oral and systemic health to underserved populations.
Authored by Andrea Clark, MS, Director of Health Care Economics, CareQuest Institute, and Caroline Le, Public Policy Analyst, CareQuest Institute
Editor’s note: Visit carequest.org to learn more about oral health’s critical role in systemic health.