Remember when your state finally started covering dental care through Medicaid? Yeah, that progress is about to get wiped out. The federal government is preparing to slash over $900 billion from Medicaid funding over the next decade, and dental benefits are likely to be the first thing states cut when money gets tight.

For the past few years, things were actually looking up. Since 2021, eighteen states expanded their Medicaid dental coverage to include checkups, X-rays, fillings, crowns, and dentures. While federal law has always required states to cover dental care for kids on Medicaid, adult coverage was optional, and most states are just now embracing it. But here’s the problem: even with these expansions, barely any adults are actually using these benefits.

According to recent data, only about 16 to 22 percent of adults on Medicaid in states with expanded coverage actually see a dentist annually. Compare that to people with private dental insurance, where roughly 50 to 60 percent visit the dentist yearly. The gap is massive, and it’s not just because people don’t know the benefits exist.

The real issue is access. Dentists aren’t signing up for Medicaid because reimbursement rates haven’t kept up with costs. In rural areas like southwestern Virginia, people are literally waiting a year just to get an appointment. One community dental center there has about 3,000 people on its waiting list. Some patients drive over two hours for care, and many still get turned away. It’s not enough to have dental coverage on paper if you can’t actually find a dentist who will see you.

This matters way beyond just tooth pain. Poor dental health is linked to serious conditions like heart disease and diabetes. It affects your ability to get jobs, eat properly, and live a healthy life overall. Star Quinn, a Tennessee mom earning around $30,000 a year, had to pay $200 out of pocket to extract an infected tooth because she couldn’t find a participating dentist. Now chewing on that side still hurts years later.

The biggest barrier? Low reimbursement rates. When dentists don’t get paid enough by Medicaid, they stop accepting patients on the program. Some states have tried mobile dental units and advertising campaigns to boost awareness, but you can’t increase demand if there’s nowhere to go.

With massive federal cuts looming, states facing budget crises will almost certainly slash Medicaid dental benefits. All the progress made in the past five years could disappear. For millions of low-income Americans in the Bay Area and beyond who finally got access to preventive dental care, that’s devastating news. We’re about to lose gains that our health system desperately needs.