Inefficient Medicaid Spending for Dental Care

Medicaid’s 50th anniversary is a time to improve access to care and use of resources

Medicaid marks its 50th anniversary at the end of July. But for many of the approximately 70 million adults and children relying on the program,1 Medicaid coverage does not translate into being able to get oral health care. Medicaid resources could be spent more efficiently and health outcomes would improve if patients received dental care when they needed it.

According to the American Dental Association, Medicaid spent more than half a billion dollars on dental-related emergency room visits in 2012. When patients do not have access to a dentist, their oral health care needs often go unaddressed until the pain becomes so severe they seek relief in an emergency room. Providing patients early and preventive care would be a more cost-effective use of the $520 million that Medicaid spent for emergency room visits—which tend to focus on pain management, not the underlying health issue.

However, only about one-third of dentists accept Medicaid. And although dental benefits through Medicaid are available to all children, adults in only 15 states have access to comprehensive dental coverage through the program. A lack of coverage can also be detrimental to states’ budgets. California, for example, eliminated comprehensive dental coverage for adults in 2009 because of budget constraints. This policy change increased the average yearly costs of visits to the emergency room by 68 percent.

Improving access to dental care for Medicaid patients requires a multifaceted approach. Evidence shows that allowing dentists to hire midlevel providers, a practitioner similar to physician assistants, lowers the cost of care and increases access for Medicaid patients so they do not have to seek relief in emergency rooms. This strategy is a more efficient use of taxpayer dollars to improve health outcomes.

Working under the supervision of a dentist, these midlevel providers—often called dental therapists—provide preventive and routine restorative care, such as filling cavities, allowing dentists to focus on more complex cases. Dental therapists already work as part of the dental team in Alaska, Minnesota, and more than 50 countries. Maine authorized their use last year. It is time for more states to do the same.

Because dental therapists perform a small number of the most commonly needed procedures, they complete their rigorous training more quickly than dentists. Research confirms that dental therapists provide high-quality, cost-effective care, which helps dentists increase the availability of treatment for their patients.

Over the past 50 years, Medicaid has provided millions of adults and children with dental benefits, but having coverage does not ensure access to quality dental care. Looking forward to the next 50 years, we need to find policy solutions to make it easier for dentists to treat Medicaid patients so that taxpayer dollars are spent efficiently.

Jane Koppelman is research director for children’s dental policy at The Pew Charitable Trusts.


  1. Seventy million adults and children are enrolled in Medicaid and the Children’s Health Insurance Program.
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