Star Quinn moved to Kingsport, Tennessee, in 2023, the same year the state began covering dental costs for roughly 600,000 low-income adults enrolled in Medicaid.
When Quinn chipped a tooth and it became infected, she struggled to find a dentist accepting Medicaid and new patients. She went to an emergency room, receiving painkillers and antibiotics, but weeks later still endured severe pain and paid $200 out of pocket for a tooth extraction. Years later, she says chewing on that side still hurts.
“You should be able to get dental care because, at the end of the day, dental care is health care,” Quinn, 34, who has four children and earns about $30,000 a year with her husband, said.
While federal law requires states to provide dental coverage for children on Medicaid, adult coverage is optional. Several states have expanded adult dental benefits in recent years, recognizing their importance to overall health. Yet access remains limited: a review of six states by KFF Health News found fewer than 1 in 4 adult Medicaid enrollees visited a dentist at least once a year.
The situation could worsen under the One Big Beautiful Bill Act, signed last year by former President Donald Trump, which is projected to cut federal Medicaid spending by more than $900 billion over the next decade. State-level losses could range from $184 million in Wyoming to $150 billion in California. Experts warn such cuts could force states to reduce or eliminate benefits, including dental coverage.
Tennessee spent nearly $64 million on adult dental care in 2024, resulting in a 20% drop in dental-related emergency visits, according to Medicaid spokesperson Amy Lawrence. However, the state is projected to lose about $7 billion in federal funding over the next decade.
As of 2025, 38 states and Washington, D.C., offered enhanced adult Medicaid dental benefits, while most others provide only limited or emergency care. Alabama provides none. Eighteen states have expanded coverage since 2021 to include checkups, X-rays, fillings, crowns, and dentures. Yet usage remains low: in 2022, no more than a third of adult Medicaid recipients saw a dentist in any state.
Recent state data shows low annual dental visit rates among Medicaid adults: Maryland 22% (2024), Oklahoma 16% (2025), Maine 13% (2025), New Hampshire 19% (2025), Tennessee 16% (2024), and Virginia 21% (2025). By contrast, 50–60% of adults with private dental insurance visit a dentist annually.
Nationwide, only 41% of dentists participated in Medicaid in 2024, a figure that has remained stable despite expansions. Many limit the number of Medicaid patients or do not accept new ones. Low reimbursement rates discourage participation, according to Marko Vujicic, chief economist at the ADA Health Policy Institute.
In southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon treats patients who often travel more than two hours but still must turn many away. Its seven residents cared for about 5,000 patients last year, with 3,000 still on a waitlist.
Other barriers for low-income adults include transportation, child care, and time off work. Poor dental health can worsen overall health, affecting conditions such as heart disease and diabetes, and can hinder employment opportunities.
Robin Mullins, 49, from rural Clintwood, Virginia, lost her bottom teeth partly due to lack of access to regular dental care. She drives nearly 90 minutes to the Abingdon clinic when she can afford time away from work and child care.
In New Hampshire, the challenge is low demand rather than supply. Medicaid recently expanded benefits to include regular care, and the state has added new dentists and mobile dental units while promoting services through media campaigns.
Experts say cultural habits and perceptions about dental care are slow to change. “Many adults on Medicaid believe you only go to a dentist when in pain,” said Brooks Woodward, dental director at Chase Brexton Health Care in Baltimore.