2026年2月27日 / 美国东部时间上午5:00 / KFF健康新闻
斯塔尔·奎恩(Star Quinn)于2023年搬到田纳西州金斯波特(Kingsport)，正是该州开始为约60万名低收入成年医疗补助(MEDICAID)参保者覆盖牙科费用的同一年。
但当奎恩的牙齿碎裂并感染后，她在家附近找不到愿意接受政府医保且新收病人的牙医。
她前往急诊室，获得止痛药和抗生素，但数周后仍剧痛难忍，最终支付200美元给一位牙医拔除了牙齿。
她说，多年后，咀嚼时该侧牙齿仍会疼痛，但奎恩——一位34岁、育有四个孩子、与丈夫年收入约3万美元的女性——至今仍在附近找不到牙医。
“人们应该能够获得牙科护理，”她说，”因为归根结底，牙科护理就是医疗保健。”
联邦政府长期以来要求各州为医疗补助计划(Medicaid)覆盖的低收入或残疾儿童提供牙科服务。然而，为成年人支付牙科费用是各州的选择。
近年来，一些州选择扩大其医疗补助计划的覆盖范围，认识到牙科护理对整体健康的重要性，从而增加获取途径。但目前，扩大成人牙科护理仍在进行中：KFF健康新闻对六个州的抽样调查显示，接受医疗补助的成年人中，每年至少看一次牙医的比例不到四分之一。
然而，根据国会共和党人去年通过《美丽法案》(One Big Beautiful Bill Act)，联邦政府计划在未来十年削减医疗补助支出超过9000亿美元。预计各州的十年损失从怀俄明州约1.84亿美元到加利福尼亚州约1500亿美元不等。
各州医疗补助计划通常根据财政状况扩大或缩减福利，而如此大规模的联邦削减可能迫使一些州缩减或取消包括牙科福利在内的服务。
里士满弗吉尼亚联邦大学牙科政策研究员希帕·纳瓦阿尔(Shillpa Naavaal)表示：”我们将失去所有已取得的成果。”
例如，田纳西州医疗补助计划发言人艾米·劳伦斯(Amy Lawrence)称，2024年该州在牙科覆盖上花费近6400万美元，牙科相关急诊就诊减少20%。
但根据新法律，田纳西州未来十年预计将损失约70亿美元联邦资金。
美国牙科协会(American Dental Association)的数据显示，截至去年，38个州和哥伦比亚特区为成年医疗补助受益人提供了增强型牙科福利，其余大多数州仅提供有限或仅限急诊的护理。阿拉巴马州是唯一不为成年受益人提供牙科覆盖的州。
自2021年以来，18个州将覆盖范围扩大至包括检查、X光、补牙、冠修复和假牙，并放宽了年度福利金额上限。
美国牙科协会12月发布的报告显示，在提供增强型福利的州，牙科福利使用率高于仅提供有限或急诊覆盖的州，但总体仍较低。2022年，任何州接受医疗补助的成年人中，看牙医的比例都不超过三分之一。
为了解最新进展，KFF健康新闻向过去五年扩大福利的三分之一州询问了最近数据：
- 马里兰州——22%（2024年）
- 俄克拉荷马州——16%（2025年）
- 缅因州——13%（2025年）
- 新罕布什尔州——19%（2025年）
- 田纳西州——16%（2024年）
- 弗吉尼亚州——21%（2025年）
相比之下，美国牙科协会称，拥有私人牙科保险的成年人中，每年至少看一次牙医的比例约为50%至60%。
美国牙科协会表示，2024年全国41%的牙医报告参与了医疗补助计划，尽管许多州扩大了牙科福利，但这一比例在过去十年保持稳定。然而，许多参与的牙医限制了接受的医疗补助患者数量，一些牙医甚至不接受新的医疗补助患者。
美国牙科协会健康政策研究所首席经济学家兼副总裁马尔科·武伊季奇(Marko Vujicic)表示，报销率未能跟上成本增长，阻碍了牙医接受医疗补助。
弗吉尼亚州西南部缺乏接受医疗补助的牙医，阿宾登的阿巴拉契亚高地社区牙科中心的执行董事伊莱恩·史密斯(Elaine Smith)称，该中心的患者需驱车两小时以上才能获得治疗，且不得不拒绝许多患者。
该中心的七名住院医师去年治疗了约5000名患者，其中大多数是医疗补助受益人。约有3000人在等待名单上，等待时间长达一年。
“这很令人难过，因为他们现在有条件看牙医，但仍然没有固定的牙科护理场所，”史密斯说。
她补充说，低收入成年人还面临其他牙科护理障碍，包括缺乏交通、儿童托管或工作休假时间。
无法看牙医的后果远超牙痛本身。不良口腔健康会导致心脏病、糖尿病等多种严重健康问题，还会增加求职难度，影响整体健康生活。
49岁的罗宾·马林斯(Robin Mullins)自2013年起断断续续参与医疗补助计划。她说，长期无法定期看牙医导致她失去了下牙。在弗吉尼亚州农村克林特伍德的家附近找不到牙医，她只能开车近90分钟到史密斯的诊所——前提是她能抽出时间（否则需放弃DoorDash的工作收入），或找到照顾特殊需求女儿的帮手。
她依靠部分假牙维持生活，但思念自然牙齿，”这太可怕了，因为你无法正常咀嚼食物。”
不过，新罕布什尔州的挑战更多源于需求不足而非牙医供应短缺。东北三角洲牙科公司(Northeast Delta Dental)管理该州医疗补助牙科项目，其首席执行官汤姆·拉菲奥(Tom Raffio)表示，公司已增加新的牙医参与，并新增两辆移动牙科车服务全州。
拉菲奥称，东北三角洲牙科公司还通过广播广告和社交媒体等方式宣传州福利。
直到2023年，新罕布什尔州医疗补助仅覆盖牙科急诊。
“文化上需要一段时间，”他说，”因为人们习惯了不去看牙医，或牙痛时才去急诊。”
总部位于巴尔的摩的蔡斯布雷克斯顿医疗中心(Chase Brexton Health Care)牙科主任布鲁克斯·伍德沃德(Brooks Woodward)称，马里兰州2024年约五分之一的医疗补助成年患者看牙医的比例”相当不错”，尽管福利仅自2023年起加强。
伍德沃德说，许多接受医疗补助的成年人认为只有疼痛时才需要看牙医，”他们一直不习惯定期看牙，这就是他们过去的生活方式。”
KFF健康新闻是一个专注于健康问题深度报道的全国性新闻机构，也是KFF（健康政策研究、民意调查和新闻的独立来源）的核心运营项目之一。
Medicaid is paying for more dental care. GOP cuts threaten to reverse the trend.
February 27, 2026 / 5:00 AM EST / KFF Health News
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 government health 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, “because 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, though, is optional for states.
In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by KFF Health News, fewer than 1 in 4 adults on Medicaid see a dentist at least once a year.
But 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 the next decade. The expected 10-year losses for individual states range from about $184 million for Wyoming to about a $150 billion for California.
State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive 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 its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.
But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.
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 their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.
Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to an ADA report released in December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.
To review more recent progress, KFF Health News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit a dentist at least once a year:
- Maryland — 22% (in 2024)
- Oklahoma — 16% (in 2025)
- Maine — 13% (in 2025)
- New Hampshire — 19% (in 2025)
- Tennessee — 16% (in 2024)
- Virginia — 21% (in 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 the dental benefit expansions in many states, the ADA says. Many participating dentists, though, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.
Reimbursement rates have not kept up with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.
Because of a lack of dentists who take 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 on Medicaid. About 3,000 people are on its waitlist, waiting up to a 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 other barriers to dental care, including a lack of transportation, child care, or time off work, she said.
The inability to see a dentist has consequences broader than tooth pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease and diabetes. It can also make it harder to do things like apply for jobs and generally lead a healthy life.
Robin Mullins, 49, who has been off and on Medicaid 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 almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.
She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”
In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.
Raffio said Northeast Delta Dental also has publicized the state benefits using 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 just are used to not going to the dentist, or going to the ER when have dental pain.”
Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.
Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” 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 — the independent source for health policy research, polling, and journalism.