Dental Coverage Through Medicaid Managed Care vs Fee-for-Service.

ABSTRACT:

Importance

Adult dental coverage under Medicaid varies widely across states and delivery systems. Most adult beneficiaries are now enrolled in managed care, yet little is known about how these benefits are structured and implemented within Medicaid managed care organizations (MCOs).

Objective

To examine trends in the generosity, delivery models, and enrollment patterns of adult dental benefits delivered through Medicaid MCOs and assess coverage alignment with Medicaid fee-for-service (FFS) coverage.

Design, setting, and participants

This cross-sectional analysis included adult Medicaid beneficiaries aged 19 years or older who had state Medicaid MCO or FFS coverage across all 50 states and Washington, DC. This analysis used a novel linked national dataset combining multiple Centers for Medicare & Medicaid Services administrative sources from 2016 to 2022. The analysis was conducted from April 8, 2025, to October 8, 2025.

Exposures

State-level Medicaid MCO or FFS program with adult comprehensive dental coverage, emergency-only dental coverage, or no dental coverage.

Main outcomes and measures

The generosity of dental benefits; the degree of alignment in benefit generosity between Medicaid MCO and Medicaid FFS programs; and enrollment of adults in dental MCO or FFS programs by benefit (coverage) type.

Results

The number of states offering comprehensive adult dental benefits through Medicaid MCOs increased from 33 (64.7%) in 2016 to 36 (70.6%) in 2022. Carve-out models, typically using stand-alone prepaid health plans for dental coverage, increased from 4 states (7.8%) in 2016 to 8 states (15.7%) in 2022. In 2016, 51.0% of states had mismatched benefit levels between MCO and FFS programs compared with 35.3% in 2022. The number of MCO enrollees with comprehensive dental coverage increased from 14.2 million (58.7%) in 2016 to 25.3 million (59.8%) in 2022, reflecting substantial managed care penetration.

Conclusions and relevance

This study found that although the generosity and scope of MCO dental benefits expanded over time, alignment with FFS programs remained inconsistent. As new legislation cuts federal funding to states, understanding how dental benefits are designed and delivered is critical to inform future coverage decisions and ensure equitable access.

SUBMITTER: Elani HW 

PROVIDER: S-EPMC12949447 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature