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

## TL;DR

The study compares how dental benefits for adults are structured and delivered through Medicaid managed care organizations versus fee-for-service programs across U.S. states.

## Contribution

The study provides a national analysis of trends in Medicaid dental coverage alignment between managed care and fee-for-service systems from 2016 to 2022.

## Key findings

- The share of states offering comprehensive dental benefits through MCOs increased from 64.7% in 2016 to 70.6% in 2022.
- Mismatched benefit levels between MCO and FFS programs decreased from 51.0% of states in 2016 to 35.3% in 2022.
- MCO enrollment with comprehensive dental coverage grew from 14.2 million in 2016 to 25.3 million in 2022.

## Abstract

How do states structure and deliver adult dental benefits through Medicaid managed care organizations (MCOs), and how do these benefits align with Medicaid fee-for-service (FFS) coverage?

In this cross-sectional analysis of Medicaid programs in all 50 states and Washington, DC, the share of states offering comprehensive dental benefits through MCOs increased from 64.7% in 2016 to 70.6% in 2022. However, benefit generosity between MCO and FFS programs remained misaligned across states despite improvements over time.

State approaches to Medicaid managed care dental coverage remain heterogeneous; strengthening alignment across delivery systems can help promote equitable access to adult dental care.

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).

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.

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.

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

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.

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.

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.

This cross-sectional analysis examines trends in the generosity, delivery models, and enrollment patterns of adult dental benefits delivered through Medicaid managed care compared with Medicaid fee-for-service programs.