Star Quinn moved to Kingsport, Tennessee, in 2023, the same year the state began covering dental costs for about 600,000 low-income adults enrolled in Medicaid.

But when Quinn chipped a tooth and it became infected, she could not find a dentist near her home who would accept her Medicaid coverage and was taking new patients.

She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old who has four children and, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said. “At the end of the day, dental care is health care.”

The federal government has long required states to offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, however, is optional for states.

In recent years, several states have expanded Medicaid dental benefits in recognition of their importance to overall health. Increasing adult dental care remains a work in progress: In a sampling of six of those states by KFF Health News, fewer than one in four adults enrolled in Medicaid see a dentist at least once a year.

Under congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to reduce Medicaid spending by more than $900 billion over 10 years. The expected 10-year losses for states range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits depending on their finances, and such federal cuts could force some to shrink or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for instance, spent nearly $64 million on dental coverage in 2024 and saw a 20% decrease in dental-related emergency room visits, said Amy Lawrence, the program’s spokesperson.

Under the new law, Tennessee is projected to lose about $7 billion in federal funding over 10 years.

As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.

Since 2021, 18 states have enhanced coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps.

Use of dental benefits in states with enhanced coverage is greater than in states with limited or emergency-only coverage, though still low overall, according to an ADA report with the latest data as of December. No more than one-third of adult Medicaid recipients saw a dentist in 2022 in any state.

To assess more recent progress, KFF Health News asked one-third of the states that expanded benefits in the past five years for their most recent data on the percentage of adults enrolled in Medicaid who visit a dentist at least once a year:

• Maryland — 22% (2024)

• Oklahoma — 16% (2025)

• Maine — 13% (2025)

• New Hampshire — 19% (2025)

• Tennessee — 16% (2024)

• Virginia — 21% (2025)

In comparison, about 50% to 60% of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite dental benefit expansions in many states, the ADA says. Many participating dentists limit the number of Medicaid patients they treat, and some do not accept new Medicaid patients.

Reimbursement rates have not kept pace with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.

Because of a shortage of dentists who accept Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them enrolled in Medicaid. About 3,000 people are on its waitlist, waiting up to one year to be seen.

“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.

Low-income adults face additional barriers to dental care, including lack of transportation, child care, or time off work, she said.

The inability to see a dentist has consequences beyond tooth pain. Poor oral health can contribute to other health problems, such as heart disease and diabetes. It can also make it more difficult to apply for jobs and maintain overall health.

Robin Mullins, 49, who has been enrolled in Medicaid intermittently since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives nearly 90 minutes to Smith’s clinic — when she can afford time away from driving for DoorDash or find care for her daughter, who has special needs.

She gets by with partial dentures but misses her natural teeth.

“It’s absolutely horrible, as you can’t chew your food properly,” she said.

In New Hampshire, however, the challenges relate more to demand than supply, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.

Raffio said Northeast Delta Dental has also publicized the benefits through radio advertising and social media, among other efforts.

Until 2023, New Hampshire Medicaid covered only dental emergencies.

“Culturally, it’s going to take a while,” he said, “as people are used to not going to the dentist or going to the emergency room when they have dental pain.”

Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly one in five adults enrolled in Medicaid seeing a dentist in 2024 “pretty good,” considering the benefits were enhanced only in 2023.

Woodward said many adults enrolled in Medicaid believe that dental visits are necessary only when they are in pain.

“They’ve just not gone to the dentist, and that’s the way it has been in their lives,” he said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.