The New Fault Lines on Fluoride in Four States — and What They Mean for Medicaid

By Matthew Steele, State and Local Advocacy Government Affairs Director, CareQuest Institute 

Across the country, there’s a new wave of proposals targeting community water fluoridation (CWF) as many states are tightening Medicaid budgets. That combination is uniquely dangerous for low-income families: 

End fluoridation -> see cavities rise -> watch public insurance spending swell. 

Recent modeling published in JAMA Health Forum projects that eliminating fluoridation nationally would increase tooth decay in children by 7.5 percentage points over five years, adding roughly 25.4 million cavities and $9.8 billion in additional dental treatment costs. Those expenses land hardest on kids covered by Medicaid, which finances about half of all pediatric dental care in the United States. 

Below are four states to watch — and why the stakes are financial and clinical. 
 

Colorado: Oral Health Funding Meets Budget Headwinds 

Colorado is already trimming Medicaid dental spending. In September 2025, the state moved to cut adult dental funding by rolling back a recent rate increase as part of broader spending reductions tied to a significant budget shortfall. The state’s Department of Health Care Policy and Financing confirmed these changes in a bulletin outlining rate reductions effective October 1, 2025. 

These cuts will make it harder for providers to participate in Medicaid and could reduce access to preventive and restorative dental care across the state. With more than 1 million Coloradans relying on Medicaid for coverage, even modest rate reductions risk widening care gaps, especially for seniors and rural residents who already face barriers to accessing dental care. 
 

Kentucky: A Live Fight over Local Opt-Outs 

In Kentucky, CWF will be front and center this upcoming week as the Interim State Government Committee is scheduled to hold an informational hearing on fluoride restriction measures that gained momentum last session. While this interim hearing carries no legislative authority, it signals that the issue remains a priority among lawmakers heading into the 2026 legislative session. 

Policy insiders in Frankfort expect that legislation will be introduced next session that will allow local water systems to opt out of fluoridation or even ban fluoride statewide. Such measures would dismantle Kentucky’s long-standing public health standard and place Kentucky among a small but growing number of states considering fluoride bans.
 

Louisiana: A Near Miss and Likely Return 

This spring, Senate Bill 2 advanced in Baton Rouge to ban fluoridation statewide, a sweeping proposal that ultimately failed in the House Health & Welfare Committee. The bill’s text made the intent explicit: to prohibit fluoridation of any public water system. While the measure was stopped during the session, it is widely expected to return in 2026. 

The debate around Senate Bill 2 revealed strong pockets of anti-fluoride sentiment in both chambers, even garnering bipartisan support in committee and floor votes. If the legislation is revived and passes in 2026, it will likely increase Medicaid and public health costs tied to preventable dental disease. 
 

Oklahoma: Fluoride, Medicaid, and a Fresh Budget Alarm 

Oklahoma has emerged as another Medicaid and fluoride defense flash point. In June 2025, state leaders withdrew Oklahoma’s public health recommendation for water fluoridation under a “Make Oklahoma Healthy Again” executive order. During the issuance of the order, the Governor even garnered federal attention by inviting US Secretary of Health and Human Services Robert Kennedy Jr. to celebrate its release. At the same time, legislators have been studying the state budget consequences of federal Medicaid reductions. 

Given the passion from the Governor’s office over the summer to recommend against CWF and the apparent planning from lawmakers to find budget savings in the state Medicaid program, we’ll be watching Oklahoma closely on the policy front in 2026. 
 

The Bottom Line

The science is settled, and the budget math is sobering. Whether your state is confronting explicit bans (Louisiana), local opt-outs (Kentucky), executive orders (Oklahoma), or Medicaid belt-tightening (Colorado), ending CWF and rolling back funding for dental Medicaid benefits are in focus for state legislatures. For lawmakers and governors, the fiscally conservative move is also the public health move: Protect fluoridation. Protect Medicaid. For advocates, the time is now to contact your legislators and encourage them to protect these resources critical to oral health care. 
 

Editor’s Note: Read more about CareQuest Institute’s advocacy work in the “Oral Health Policy Perspective” series.