At the state level, NADP has closely monitored trends in Medicaid expansion, Medicaid coverage of adult dental benefits, and the creation of State-based Marketplaces (SBMs). States that establish SBMs like New Jersey, Pennsylvania, and Nevada have provided an opportunity to establish the independent purchase of dental plans on exchanges. Two states, Oklahoma and Missouri, approved Medicaid expansion through ballot initiatives, following a trend from 2018 of rural states approving Medicaid expansion. NADP also closely monitored state Medicaid and marketplace waiver applications to the Centers for Medicare and Medicaid Services (CMS), advocating for the first time on waivers that would harm dental benefits availability, such as the potential elimination of the federal marketplace in Georgia. In addition to Georgia, several states, such as Oklahoma and Nebraska, announced updates regarding dental benefits in their Medicaid programs.