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Medicaid Adult Dental Benefit Expansion
Medicaid Adult Dental Coverage Checker
The Medicaid Adult Dental Coverage Checker is an interactive tool for policymakers, administrators, and advocates to easily understand where a given state’s Medicaid adult dental benefits package falls on a continuum from no dental benefits to extensive benefits, helping identify areas for improvement and expansion. It looks at coverage of specific procedures and services, including allowed frequency, in eight service categories.
The Coverage Checker displays results that were self-reported by state Medicaid dental directors or their equivalent in a survey conducted in the spring of 2023. The data represent a snapshot in time and are reflective of the benefit package in place as of December 31, 2022. It's important to note that several states have implemented new and expanded benefits for all adults in early 2023, which are not captured in the Checker. Please find information about these newly expanded benefits in the tooltip for each state within the dashboard below.
Consumer Disclaimer: This dashboard is intended as a resource for Medicaid agencies, legislators, policymakers and advocates. It is not intended as a resource for consumers or Medicaid beneficiaries. The procedures and dental codes included and assessed in the survey — and displayed here — are intended to be representative of the hundreds of dental procedures contained in the ADA’s Current Dental Terminology code set. The sample is not exhaustive and should not be considered as constituting a complete benefits package. We encourage you to contact your state’s Medicaid agency for information regarding the Medicaid adult dental benefit.
Featured Resources
States That Expanded Medicaid Adult Dental Benefits in Early 2023
Hawaii
The state eliminated all non-emergency dental benefits for adult Medicaid beneficiaries in 2008 during the economic downturn. Since that time, adult beneficiaries have been covered for pain management and tooth extraction only. Advocates have long called for a restoration of benefits and have repeatedly worked to advance legislation to do so.
Hawaii’s new Medicaid adult dental benefit took effect on January 1, 2023. The Hawaii Department of Human Services, Med-QUEST Division announced that prevention and control of oral disease will be covered, including cleanings and dental procedures such as x-rays and fillings. Coverage will also include restoration of chewing functions which, based on the individual case, may include root canals, crowns and/or dentures.
| Services Offered | |
| December 31, 2022* | On or soon after January 1, 2023* |
|
|
Maryland
After years of sustained advocacy and incremental expansions, the Maryland Legislature approved SB150 on April 6, 2022, creating a Medicaid dental benefit for all adults. The Legislature included a fiscal note of $66M for the first six months of the program and an additional $132M for FY 2024. The bill was signed by Governor Larry Hogan on May 12, 2022. Effective January 1, 2023, all adult beneficiaries now have access to diagnostic, preventive, restorative, endodontic, periodontal, and oral surgery services.
| Services Offered | |
| December 31, 2022* | On or soon after January 1, 2023* |
| None** |
|
**Prior to January 1, 2023, Maryland provided a wide range of dental benefits to pregnant adults, former foster care recipients under age 26, and individuals enrolled in the Rare and Expensive Case Management Program. The state also provided a limited benefit ($800 per year) through the Medicaid Adult Dental Waiver Program for adults who are dually enrolled in Medicaid and Medicare
Michigan
In October 2022, the Michigan Department of Health and Human Services (MDHHS) submitted a proposal 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. Effective April 1, 2023 the adult dental benefit expanded and now includes coverage for x-rays, cleanings, fillings, crowns, root canals, periodontal services, dentures, and extractions.
Program changes in the design reflect input from a broad array of stakeholders and lessons learned from the Healthy Michigan Plan and Pregnant Women dental programs. In addition to the expanded services, MDHHS has made changes to improve beneficiary access and provider participation, as well as expand access to robust care coordination services that ensure beneficiaries are supported in accessing the services they need.
| Services Offered | |
| December 31, 2022* | On or soon after January 1, 2023* |
|
|
New Hampshire
The state has historically offered an emergency-only Medicaid dental benefit to its adult beneficiaries. After years of sustained advocacy, the state began offering an expanded benefit for all adults on April 1, 2023. The benefit includes diagnostic, preventive, restorative, oral surgery, and dentures with an annual benefit maximum of $1,500.
The New Hampshire Legislature passed companion bills in the House and Senate which created the dental benefit for all adults. It is estimated that the new benefit will cost approximately $24M ($6.9M in state funding and $17M in federal funding). As outlined in the bills, the state funding portion will come from the $21 million state settlement with Centene Corporation. Governor John Sununu signed the bills on July 1, 2022 and the new benefit took effect on April 1, 2023.
| Services Offered | |
| December 31, 2022* | On or soon after January 1, 2023* |
|
|
** Dentures will not be a benefit for all adult members. Adults with developmental disabilities, acquired brain disorders, and seniors and adults with chronic illness or disabilities enrolled in the Choices for Independence program will have coverage for dentures.
Tennessee
Historically the state has not offered a dental benefit to adult beneficiaries. In January 2022, the state announced it would begin providing extensive dental coverage to pregnant and postpartum beneficiaries beginning on April 1, 2022. In February, Governor Bill Lee released his budget recommendations which included $75M ($25M in General funds and $50M in Federal funds) to provide dental benefits to all adult beneficiaries. Effective January 1, 2023, adult beneficiaries now have access to diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, extraction, and oral surgery services.
In addition to including the Governor’s recommendation in its approved budget, the Legislature also included funding for a dental provider rate increase as well as $11.8M (general funds) to support dental schools in effort to ensure an adequate provider network to care for adults with newly acquired dental coverage. Funding will be used to expand the class sizes at the state’s two existing dental schools (Meharry Medical College School of Dentistry and University of Tennessee College of Dentistry), recruit and retain dentists through loan repayment, and expand prosthodontic services. In addition, Lincoln Memorial University (LMU) will open a dental school in the fall of 2022, and the budget includes $3M to establish a pilot program to serve East Tennessee in partnership with the LMU-College of Dental Medicine.
| Services Offered | |
| December 31, 2022* | On or soon after January 1, 2023* |
| None** |
|
**As of April 1, 2022, TennCare provides a dental benefits package for beneficiaries for the duration of their pregnancy and postpartum coverage (12 months coverage following the end of pregnancy). Benefits include diagnostic x-rays and exams; preventive cleanings; topical fluoride treatments and caries arresting medicament; restorative (fillings); endodontics (1 root canal per member per eligibility period); scaling and root planing; full mouth debridement; crowns (2 per member per eligibility period); complete dentures; immediate complete dentures and complete denture relines; tooth extractions; alveoloplasty; removal of lateral exostosis; removal of torus palatinus; removal of torus mandibularis; and palliative treatment. (source)
*Based on services and procedure codes assessed in 2022 Rubric. Please note that the procedures and dental codes included and assessed in the survey are intended to be representative of the hundreds of dental procedures contained in the ADA’s Current Dental Terminology code set. The sample is not exhaustive and should not be considered as constituting a complete benefits package.
Tools for Oral Health Advocates
Medicaid Adult Dental Benefit Toolkit for Advocates
This toolkit contains resources that reveal why dental coverage is so important for lower-income Americans and materials to review and share with policy makers.
Cutting Medicaid Adult Dental Benefits Would Hurt States in Unexpected Ways
Cutting Medicaid adult dental benefits could harm job growth, increase costs, and harm states in other unexpected ways. Providing adult dental coverage can improve job prospects, reduce costly visits to hospitals, save states money, and increase the likelihood of children getting dental care.
Contact Your Local Officials
Contact your local officials to advocate for state or federal expansion of adult dental benefits.
How States Are Using The Coverage Checker
Strengthening Connecticut Medicaid Adult Dental Benefits
“By failing to treat periodontal disease,” she says, “it is like allowing an infection in a person’s lower limb to progress to gangrene where the ultimate treatment is amputation.” Donna Balaski, DMD hopes her analogy — and her research-backed words of advocacy — will soon reach the ears of state leaders and lawmakers, inspiring them to strengthen Medicaid adult dental benefits in Connecticut. She knows the far-reaching effects benefits can have on access, equity, and the health of individuals in every corner of the state.
How West Virginia Is Using the Medicaid Adult Dental Coverage Checker
The Medicaid Adult Dental Coverage Checker doesn’t just provide numbers — it tells a story that oral health leaders can tell state lawmakers. “I think when you first see it, it’s kind of shock and awe. It confirms where you’re at. But once you get past that, then you start to visualize how you can use the tool to implement change,” says Jason Roush, DDS, dental director in West Virginia, about the Medicaid Adult Dental Coverage Checker in a new blog post.
Maryland’s Successful Path to Securing Dental Coverage for Low-Income Adults
It was the tragic death of 12-year-old Deamonte Driver — a boy who died from an untreated tooth infection that spread lethal bacteria to his brain — that first compelled advocates in Maryland to take up the fight to expand dental coverage to low-income children in 2007. As they made meaningful advances in dental coverage for children in Maryland, the organization at the forefront of this work, the Maryland Dental Action Coalition (MDAC), then turned its attention to expanding dental coverage for adults on Medicaid.
Acknowledging Our Partners
The Rubric for Assessing Extensiveness of State Medicaid Adult Dental Benefits was developed in partnership with a core group and an advisory committee of experts in the field. After significant expansion and restoration of Medicaid adult dental benefits in several states several years ago, CareQuest Institute and the ADA Health Policy Institute collaborated to update the ADA’s classification of states.
Buoyed by these policy wins, CareQuest Institute shared that new round of classifications with grantees and partners and realized there was an appetite to form a larger workgroup. That workgroup quickly decided the oral health community would benefit from a new assessment tool, something that would move the industry beyond simply counting the number of procedures covered. The Coverage Checker is the output of that yearslong effort.
Core Group Organizations:
American Dental Association Health Policy Institute (ADA HPI)
Center for Healthcare Strategies (CHCS)
National Academy for State Health Policy (NASHP)
CareQuest Institute for Oral Health
Advisory Committee Members:
Stacey Auger, MPH, Policy Consultant, CareQuest Institute for Oral Health
Donna Balaski, DMD, Healthcare Administration Management, State of Connecticut, Department of Social Services Division of Health Services
Stacey Chazin, MPH, MSODL, Health Policy and Leadership Consultant, formerly with the Oral Health Progress and Equity Network
Dora Fisher, Formerly Director of Older Adult Programs, Oral Health America
Chelsea Fosse, DMD, MPH, Senior Health Policy Analyst, American Dental Association Health Policy Institute
Steven Geiermann, DDS, Retired, Senior Manager, Access, Community Oral Health Infrastructure and Capacity, American Dental Association Council on Advocacy for Access and Prevention
Tracy Gilman, CDA, MSM, Regional Director, MassHealth Contract at DentaQuest
Carrie Hanlon, MPP, Project Director, National Academy of State Health Policy
Robert Isman, DDS, MPH, Formerly Dental Program Consultant, California Department of Health Care Services
Michael Monopoli, DMD, MPH, MS, FACD, FICD, Formerly Vice President for Grant Strategy, CareQuest Institute for Oral Health
Bianca Rogers, Formerly Advocacy Coordinator, Oral Health America
Andrew Snyder, MPA, Formerly Project Director, National Academy of State Health Policy
Madeline Steward, MPH, Program Officer, Center for Health Care Strategies
Cassandra Yarbrough, MPP, Formerly Lead Public Policy Analyst, American Dental Association Health Policy Institute