Dr. Scott Miller knows the cost of every dental procedure he performs. A standard, non-surgical tooth extraction, for instance, costs $92.39.
Recently, Miller treated a patient who needed 23 teeth removed. Just the extractions would cost over $2,000, not including the dentures the patient also required.
Under a provision in Gov. Glenn Youngkin’s proposed budget, that patient might not be able to complete the treatment in a single year. The budget includes a $2,000 annual cap on adult dental services under Medicaid, which currently has no such limit.
Once a Medicaid enrollee reaches the $2,000 threshold, coverage for additional dental care would pause until the benefit renews the following year. Patients would either pay out-of-pocket or delay treatment.
Expanding Adult Dental Coverage
Virginia began offering separate dental benefits under Medicaid in 2005, primarily for children and pregnant women. In 2021, the program expanded to include all adults, covering roughly 750,000 residents.
Miller founded the Appalachian Highlands Community Dental Center, a nonprofit in Abingdon that serves uninsured, underinsured, and Medicaid patients across Southwest Virginia. Since opening in 2020, the clinic has become the region’s largest provider of adult Medicaid dental care. Demand continues to exceed capacity, with a waitlist of about 3,000 patients.
The clinic is expanding to accommodate more people.
“We see patients who have delayed care for decades,” Miller said. “Many come in with extensive decay.” In severe cases, teeth are beyond repair and must be removed.
A Vulnerable Patient Base
Over 70% of Miller’s patients rely on Medicaid. Many are coal miners or members of mining families. Some are recovering from opioid or methamphetamine addiction. Others earn too much to qualify for Medicaid but cannot afford dental insurance, relying on the clinic’s sliding-fee scale.
Legislative Response
Del. Rodney Willett, D-Henrico County, proposed an amendment to remove the cap, but he said it is unlikely to advance this year due to numerous health care priorities and budget shortfalls. “We have a lot of people to take care of,” Willett said.
Sen. Todd Pillion, R-Washington County, is also working to remove the cap. A pediatric dentist in Bristol, Pillion sees many Medicaid patients. “We were fortunate in Virginia to expand adult dental Medicaid benefits,” he said. “We’ve seen great results and want to continue them.”
The legislature is scheduled to adjourn on Saturday.
Impact on Patients and Providers
Dentists warn the cap could force difficult decisions in the exam room. Multi-step treatment plans can easily exceed $2,000, potentially leaving patients with incomplete care. Pillion added that the limit could also discourage dentists from accepting Medicaid, further restricting access for vulnerable adults.
