Medicaid changes could threaten children’s dental coverage and raise costs
Modeling study by HSDM researchers estimates healthcare costs associated with loss of dental coverage for children would be nearly $87 million over 10 years
Currently more than 37 million children and teens in the U.S. under the age of 19 rely on Medicaid coverage for dental care. It offers a critical safety net to children from low-income families without dental insurance, providing preventative care that keeps children out of emergency rooms for nontraumatic dental conditions.
New administrative requirements and conditions for Medicaid eligibility, including work reporting requirements, were enacted in 2025 under the One Big Beautiful Bill Act (OBBBA). Under the new requirements, projections suggest that 480,000 U.S. children per year could be disenrolled from Medicaid between 2025 and 2034. Researchers at Harvard School of Dental Medicine (HSDM) studied the impact of children losing dental coverage at this scale and recently published their findings in JAMA Network Open.
Under a Medicaid plan, a 7-year-old from a low-income family who develops cavities can receive a dental exam, x-rays, and fillings at no cost to the family. If the child loses Medicaid coverage and becomes uninsured, the family faces an estimated $570 bill for treatment out of pocket. Without timely treatment, a cavity can progress to a painful tooth abscess, which is more costly to treat and associated with infection and other negative health outcomes.
Using data from 11,696 children under age 19 from the U.S. National Health and Nutrition Examination Survey, the researchers used decision-analytic modeling to project costs and oral health outcomes for children whose families lose Medicaid coverage.
“What we found was that even under conservative assumptions, coverage loss doesn't make costs disappear — it shifts them. Children who lose Medicaid don't stop getting cavities; they stop getting treated early," said Dr. Sung Eun Choi, assistant professor in Oral Health Policy and Epidemiology at HSDM, and lead author of the study. “What begins as a preventable disease can progress to infections, lead to emergency visits, and accumulate into nearly $87 million in additional system-level costs over a decade. Those costs fall on hospitals, safety-net providers, and families themselves.”
Without the preventative dental care and early screenings provided by Medicaid coverage, the study also estimates 95,799 additional cases of tooth decay in children over 10 years. For many low-income families, the cost of paying out of pocket for regular cleanings, or fillings to fix their child’s cavities, will be beyond what they can afford.
37M
Children and teens under age 19 rely on Medicaid for dental coverage
480,000
Estimated number of U.S. children projected to lose Medicaid coverage each year between 2025 and 2034
$87M
Projected additional healthcare costs over 10 years
95,799
Estimated additional cases of tooth decay in children over 10 years
“No family should be forced to make the choice between a needed dental visit and putting food on the table. Our findings show that this untreated disease cascades into further harm for children in their families, in the form of both economic costs as well as pain, visits to the emergency department, and missed work and school,” said author Dr. Lisa Simon, assistant professor in Oral Health Policy and Epidemiology at HSDM, and associate physician at Brigham and Women’s Hospital.
The authors note that one of the more counterintuitive findings was that when children lose coverage, fewer cavities get treated, which can make costs appear lower in the short term. However, that apparent savings comes at the expense of children’s health in the form of missed school days, lost productivity, and downstream disease that the researchers’ model does not fully capture.
“Even when focusing only on dental care costs, the evidence is clear that coverage disruptions are not cost-neutral, and the true burden is likely higher,” said Choi. “These findings highlight that coverage decisions carry consequences that extend beyond immediate budgets and should be considered in long-term policy planning.”
This study was supported by the National Institute of Minority Health and Health Disparities of the National Institutes of Health, and the Initiative to Integrate Oral Health and Medicine.