JAMA study projects pediatric Medicaid disenrollment would worsen oral health, raise health care costs 

ADA says findings reinforce need for comprehensive Medicaid dental coverage 

A new study published in JAMA Network Open projects that pediatric Medicaid coverage losses could lead to worsening oral health outcomes and higher health care costs, reinforcing longstanding concerns from organized dentistry about the consequences of disruptions in dental coverage for vulnerable populations. 

The study, “Projected Oral Health Outcomes and Costs Associated With Pediatric Medicaid Disenrollment,” examined the potential oral health impact of Medicaid coverage reductions under the 2025 One Big Beautiful Bill Act. Using a microsimulation model based on nationally representative data from the National Health and Nutrition Examination Survey, researchers projected that Medicaid disenrollment among children could result in nearly 96,000 additional cases of dental caries and $86.5 million in added health care costs over a 10-year period. 

Researchers also projected 7,367 additional emergency department visits for nontraumatic dental conditions and the loss of more than 27,000 quality-adjusted life-years under the study’s base-case scenario. 

The authors concluded that Medicaid “plays a critical role in children’s access to dental care and oral health” and that coverage disruptions may increase untreated dental disease and overall system-level costs. 

The study noted that Medicaid currently provides comprehensive dental coverage to more than 37 million children through the early and periodic screening, diagnostic, and treatment benefit. Researchers projected that approximately 480,000 children per year could lose Medicaid coverage between 2025 and 2034 under proposed policy changes. 

Emily Mattingly, D.D.S., chair of the ADA Council on Advocacy for Access and Prevention, said the findings align with concerns the dental community has raised for years about the importance of maintaining comprehensive dental coverage for children. 

“Ongoing research continues to demonstrate that Medicaid disenrollment and reductions in dental benefits can negatively impact access to care, oral health outcomes and overall health care costs for children,” Dr. Mattingly said. “Preventive oral health care remains an essential component of overall health. The findings published in JAMA reinforce what organized dentistry has continued to emphasize: that maintaining comprehensive Medicaid dental coverage for children is critical to prevention, early intervention and reducing costly emergency care utilization.” 

Dr. Mattingly also pointed to persistent disparities in dental utilization among children enrolled in public coverage programs. 

“Nationally, only 49% of pediatric Medicaid and CHIP beneficiaries visited a dentist in 2024, compared to 67% of privately insured children,” she said. “In 27 states, less than half of pediatric patients insured by Medicaid and CHIP had a dental visit in the past year, further demonstrating the ongoing barriers many children face in accessing oral health care.” 

The new JAMA study echoes findings from a 2025 analysis conducted by the ADA Health Policy Institute examining the consequences of eliminating adult Medicaid dental benefits. 

In a report titled “What Happens if the Adult Medicaid Dental Benefit Goes Away?”, HPI estimated that removing adult Medicaid dental benefits would increase U.S. health care costs by approximately $1.9 billion in a single year due to increased emergency department utilization and worsening health outcomes among patients with diabetes, coronary artery disease and pregnancy-related periodontal complications. 

The HPI report also highlighted evidence from several states showing that reductions in adult Medicaid dental benefits were associated with increases in emergency department visits, hospital admissions and surgical interventions for dental conditions. In Illinois, for example, emergency department visits increased by 48% after the state scaled back adult Medicaid dental coverage to emergency-only services. 

Researchers with the JAMA study similarly emphasized that reduced access to preventive dental care can shift costs elsewhere in the health care system as untreated disease progresses and patients increasingly rely on hospital emergency departments for care. 

The JAMA authors said the findings suggest that “even moderate coverage disruptions may have disproportionate impacts on socioeconomically vulnerable children.” 

“While these incremental costs represent a small fraction of total U.S. health expenditures, they reflect preventable disease burden concentrated among socioeconomically vulnerable children, for whom even modest coverage disruptions may have disproportionate clinical and functional consequences,” the study concluded. “These findings underscore the central role of Medicaid in supporting preventive dental care and limiting downstream disease burden among children.”