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Dental Coverage Through Medicaid Managed Care vs Fee-for-Service
Hawazin W Elani1,2, Ningsheng Zhao1, Jacob Wallace3
1Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts.
JAMA Health Forum
|February 27, 2026
Summary
Medicaid managed care organizations (MCOs) expanded adult dental benefits, but coverage generosity and delivery models remain inconsistent with fee-for-service (FFS) plans. Understanding these trends is crucial for equitable dental access.
Area of Science:
- Health Services Research
- Public Health Policy
- Dental Benefits Administration
Background:
- Adult dental coverage within Medicaid programs exhibits significant state-level variation.
- The majority of adult Medicaid beneficiaries are now enrolled in managed care plans, yet details on benefit structures within these organizations are limited.
Purpose of the Study:
- To analyze trends in the scope, delivery, and enrollment patterns of adult dental benefits offered by Medicaid managed care organizations (MCOs).
- To evaluate the alignment of dental benefit generosity between MCOs and Medicaid fee-for-service (FFS) programs.
Main Methods:
- A cross-sectional analysis of adult Medicaid beneficiaries (19+ years) with MCO or FFS coverage across all 50 states and Washington, DC.
- Utilized a linked national dataset from Centers for Medicare & Medicaid Services administrative sources (2016-2022).
Main Results:
- States offering comprehensive adult dental benefits via MCOs increased from 64.7% in 2016 to 70.6% in 2022.
- Mismatched benefit levels between MCO and FFS programs decreased from 51.0% in 2016 to 35.3% in 2022.
- Comprehensive dental coverage enrollment among MCO beneficiaries rose from 14.2 million (58.7%) in 2016 to 25.3 million (59.8%) in 2022.
Conclusions:
- While MCO adult dental benefits have grown, their alignment with FFS programs remains inconsistent.
- The evolving landscape of Medicaid dental benefits necessitates careful consideration for future policy decisions to ensure equitable access.
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