Medicaid Dental Benefits and the One Big Beautiful Bill Act

By Mike Adelberg, NADP Executive Director

On July 4, President Trump signed One Big Beautiful Bill Act (OBBA) into law. Much has been written about the new law and how it may impact Medicaid, so there’s no need to re-hash what is already known. Instead, I will discuss how the law might impact the oral health of tens of millions of Americans with Medicaid. “Might” is the operative word here. The bill just passed; it will take many months to regulate and phase in the key provisions.

I want to briefly level-set on the state of dental benefits in Medicaid today. States must provide dental care to minors, but it is optional for adults. Though optional, most states offer at least limited dental coverage, and the majority of states offer comprehensive adult dental coverage. States make this choice for sensible reasons—good oral health improves overall health and makes people more employable. Dental care is largely self-financing; several studies show that appropriate dental care results in significant savings elsewhere in the healthcare spend, including reducing the number of very expensive and avoidable emergency hospital admissions.

Nevertheless, while the public policy and business case for providing adult dental in Medicaid is clear, states will be tempted to weaken their dental coverage in the next few years. This is because the law includes provisions that will constrict Medicaid funding—by trimming the Medicaid rolls and reducing provider taxes that bolster Medicaid budgets. Comprehensive adult dental is among the more expensive non-mandatory benefits in the states that offer it; some states trimmed adult dental coverage during past funding squeezes.

Rather than belabor this point, I pivot to three aspects of the law where states have significant latitude to implement the law in the most responsible way.

Eligibility Redeterminations: Under the law, Medicaid recipients will need to demonstrate semi-annually that they remain eligible for Medicaid. The eligibility provision requires the states to use national address databases, review a Master Death File at least quarterly, and prevent recipients from concurrent enrollment in multiple states. As states implement this provision, they should seek to limit the number of people who, due to a submission error, cannot stay on Medicaid.

Work Requirements: Under the law, able-bodied Medicaid recipients between 19 and 64 years will need to document 80 hours a month of employment or equivalent activity. Prior experience suggests that many people who meet these criteria do not submit documentation in the manner required by the state—resulting in avoidable terminations. States will have latitude to make this process user-friendly and forgiving, or hard-to-use and arbitrary. We should seek to limit the number of people who, due to a submission error, cannot access necessary healthcare.

Cost Sharing: The new law also requires cost-sharing for certain Medicaid recipients on many of their healthcare services. States will have latitude to set the cost sharing up to $35 per service. On this matter, I need to be very clear: high cost-sharing will drive people away from necessary preventive dental care. Increasing cost sharing on preventive dental care will lessen utilization and worsen health outcomes. In most commercial dental plans, preventive dental services have no cost sharing. We could easily see a troubling scenario in which people near the federal poverty level (with Medicaid) have cost sharing for dental check-ups while white collar workers with six figure salaries get those same services without cost sharing. There is a way out of this… Under the law, preventive medical services are exempted from cost sharing;  policy makers could include preventive dental services in this carve-out via regulation.

OBBBA presents significant implementation and policy challenges for the Medicaid community. NADP looks forward to working with states and the Administration to make that process successful and urges policymakers to continue to prioritize access to dental benefits.