Enter your email to receive the CareQuest newsletter:
July 16, 2024
By Stacey Auger, MPH, policy consultant, CareQuest Institute
Oral health has been in the national spotlight recently thanks to a May 16 hearing of the Senate Committee on Health, Education, Labor, and Pensions (HELP). The focus of the hearing was the dental crisis facing the US and how to make dental care more affordable and available to all.
State policymakers and advocates are also recognizing the crisis our country is facing — and they are not waiting for federal action to make change. As we’ll explore below, Medicaid adult dental coverage has continued to gain traction, as the number of states that are expanding adult dental benefits continues to grow! For anyone newer to the topic of Medicaid dental coverage, states are required to provide comprehensive dental benefits for children covered by Medicaid and the Children’s Health Insurance Program (CHIP).
For adult Medicaid beneficiaries, however, dental coverage is optional, and states can limit the type or number of services and beneficiary groups they will cover. States can also exclude adult dental services entirely. As a result, there is wide variation in Medicaid adult dental benefits across states — even across beneficiary groups within some states. This landscape changes every year as states add to or reduce their coverage offerings.
At CareQuest Institute, we are pleased to release the 2023 Medicaid Adult Dental Coverage Checker, which shows the landscape for Medicaid adult dental benefits and can inform both federal- and state-level policymaking conversations.
What have we learned? That’s what we’ll break down below.
New Benefits Data Paint a Promising Picture
As we noted at this time last year, the period between 2020 and 2022 marked one of the most significant expansions of Medicaid adult dental benefits in recent decades. This expansion continued into 2023, as illustrated by the newly updated Medicaid Adult Dental Coverage Checker (Coverage Checker).
For those unfamiliar with the Coverage Checker, it is an interactive tool designed for policymakers, administrators, and advocates to better understand where a given state’s Medicaid adult dental benefits package falls on a continuum from no dental benefits to extensive benefits. It looks at coverage of specific procedures and services, including allowed frequency, in eight service categories. It allows stakeholders to self-identify areas for improvement and expansion, while charting a course for the additional benefits.
The Coverage Checker includes data self-reported by state Medicaid dental programs in a survey developed by the American Dental Association Health’s Policy Institute (ADA HPI), the Center for Health Care Strategies (CHCS), and an advisory committee of state and national leaders.
The Coverage Checker now includes data from surveys completed in 2020, 2022, and 2023. Let’s dive into the most notable takeaways from the newest data:
- The number of states that offer an extensive Medicaid adult dental benefit to all adult beneficiaries has increased again.
In 2020, the first time we collected data through the Coverage Checker, three states and the District of Columbia provided an extensive dental benefit to the largest group of Medicaid adult beneficiaries ages 21–64.
Today, that number has grown to nine: Alaska, Hawaii, Iowa, Maine, Montana, New Jersey, Tennessee, Wisconsin, and the District of Columbia.
New and significant expansions of benefits went into effect in 2023.
Between 2020 and 2023, 26 states expanded their dental benefit offerings. Four states (Kansas, Michigan, North Dakota, and South Dakota) expanded their benefits twice during that time. As the Coverage Checker now shows, 12 states expanded their benefit offerings by one or more services in 2023 (e.g., cleaning, periodontal services, complete dentures), with the largest expansions taking place in seven of these states.
These seven states — Hawaii, Kansas, Kentucky, Maryland, Michigan, New Hampshire, and Tennessee — implemented significant improvements in benefits for all of their adult members in 2023. As a result of the improvements, Hawaii and Tennessee now provide an extensive benefit to all adult beneficiaries.
The benefit improvements are outlined below to demonstrate the variety of policy and advocacy pathways that can advance significant benefit improvements. Each of these wins is the result of years of relentless advocacy by countless local and state champions, including advocates, beneficiaries, caregivers, service providers, health professionals, academics, state officials, and lawmakers.
Hawaii
On January 1, 2023, Hawaii implemented its new Medicaid adult dental benefit, which was included in the state’s FY2023 budget. Focusing on prevention and control of oral disease, a full range of services are now provided, including X-rays, examinations, cleanings, application of fluoride, fillings, crowns, root canals, periodontal services, dentures, and extractions.
This is a considerable improvement in benefits, as the state had only covered pain management and tooth extractions for adult beneficiaries since 2008.
Kansas
As of 2023, Kansas covers a wide range of services including fillings and crowns, periodontal care, silver diamine fluoride, full and partial dentures, and denture repairs. In both 2022 and 2023, Kansas policymakers included funding in the state budget to extend dental benefits. In addition to what is reflected in this year’s Coverage Checker, Kansas will implement a further expansion of its benefits package to include examinations and cleanings later this year (anticipated around July 1, 2024). These wins build on several years of incremental improvements to strengthen the adult dental program.
These improvements will greatly benefit Kansans who rely on Medicaid, as the state only offered emergency extractions since eliminating dental benefits in 2010.
Kentucky
Effective January 1, 2023, Kentucky Medicaid has covered for a range of new dental services, including cleanings, crowns, root canals, and dentures for all adult beneficiaries. Previously, the state provided only diagnostic services, limited preventive and restorative services, and extractions.
On October 20, 2022, Governor Andy Beshear announced a new initiative to help boost workforce participation by improving health coverage of dental-, vision-, and hearing-related care.
While the Kentucky legislature challenged this new coverage because it originally took effect through emergency regulations, these benefits are still active and Medicaid beneficiaries are eligible for the expanded dental benefits.
Maryland
Effective January 1, 2023, all of Maryland’s Medicaid adult beneficiaries now have access to diagnostic, preventive, restorative, endodontic, periodontal, and oral surgery services.
The Maryland Legislature approved SB150 on April 6, 2022, creating a Medicaid dental benefit for all adults. This benefit expansion built upon the state’s successful Adult Dental Pilot program for adults ages 21–64 dually eligible for both Medicaid and Medicare, as well as its expanded benefits for pregnant and postpartum adults.
Michigan
Effective April 1, 2023, Michigan Medicaid implemented adult dental benefits that now include coverage for X-rays, cleanings, fillings, crowns, root canals, periodontal services, dentures, and extractions.
In October 2022, the Michigan Department of Health and Human Services (MDHHS) submitted a proposal to the legislature to redesign the Medicaid adult dental benefit. The Legislature approved the redesign in December 2022, and MDHHS began rolling out improvements in January 2023 with a significant increase in provider reimbursement rates.
New Hampshire
Starting April 1, 2023, New Hampshire implemented a new adult dental benefit that includes diagnostic, preventive, restorative, and oral surgery services, as well as dentures (for certain adults) with an annual benefit maximum of $1,500.
The state has historically offered an emergency-only Medicaid dental benefit to its adult beneficiaries. In 2019, Governor Chris Sununu signed legislation removing a provision that prohibited a mandatory dental benefit within New Hampshire’s managed care model. The legislation also directed the New Hampshire Department of Health and Human Services to create a designated working group to develop comprehensive adult dental benefits for incorporation into a value-based care platform. After years of work to craft the benefit and sustained advocacy to implement it, the state began offering an expanded benefit for all adults.
Tennessee
Effective January 1, 2023, adult beneficiaries in Tennessee now have access to diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, and oral surgery services, including extractions.
Historically, the state had not offered a dental benefit to adult beneficiaries. In January 2022, the state Medicaid agency announced it would begin providing extensive dental coverage to pregnant and postpartum beneficiaries beginning on April 1, 2022. A year later, the state expanded benefits again to all adults.
- States are increasing their annual benefit maximums on dental services or eliminating them entirely.
As of 2023, 34 states place no dollar limit on dental services that each Medicaid member can receive each year (up from 32 in 2022). There are 14 states that have an annual benefit limit of $1,000 or greater (up from 4 in 2022), and 2 states continue to have an annual benefit limit of less than $1,000.
- States continue to provide enhanced coverage to certain groups of adults.
Recognizing the distinct oral health needs of certain groups of adult beneficiaries, some states have opted to provide additional or enhanced services to these groups — most notably pregnant and postpartum adults, those with certain health conditions, adults with intellectual and/or developmental disabilities, and those utilizing long-term care.
In 2023, 20 states reported that they offer different coverage to specific groups of beneficiaries than they offer to other adult beneficiaries ages 21–64.
Check out our report on coverage offered to specific beneficiary groups as of December 2022, and keep your eyes open for an updated report later this summer.
- Expansions and improvements to Medicaid adult dental benefits have continued into 2024.
The survey used to inform the Coverage Checker is a point-in-time survey, and this year’s survey assessed coverage in place as of December 31, 2023. Yet states are continually making updates to their adult dental coverage; six states — Connecticut, Kansas, Minnesota, Nebraska, Utah, and West Virginia — either implemented improvements on January 1, 2024, or plan to do so later in the year. Other states are still considering legislation that may result in benefit improvements in the near future. The Coverage Checker page details these ongoing improvements, which will be reflected in next year’s survey.
Editor’s Note: You can find more details about these changes on the Coverage Checker web page. We’ll be updating the page as the year goes on with additional state updates and new reports based on our findings, so be sure to check back regularly.