The Cost of the GOP’s Medicaid Cuts: ER Bills for States and a Spiraling Oral Health Crisis
Dentist Dr. Tara Prasad thinks a lot about the logistics of homelessness — how difficult it is to brush your teeth when you don’t have a place to store a toothbrush, or how to protect a life-changing set of dentures when you’re sleeping and someone may steal your belongings. Prasad is the dental director at Boston Health Care for the Homeless Program, where she often sees patients who have delayed dental care for a long time.
Prasad and oral health providers in several states are bracing for impact as the fallout of HR1, also known as the One Big Beautiful Bill Act, descends upon state legislatures. The budget law’s cuts to Medicaid — to the tune of over $900 billion over the next 10 years — are now being passed on to state legislatures.
“This is a movie we’ve seen before,” said Alex Sheff, senior director of policy and government relations at the advocacy group Health Care for All Massachusetts. In lean times, optional Medicaid adult dental benefits have often been the first on the budget chopping block as states search for ways to make up for shortfalls. But history has shown that these cuts are a fool’s bargain, with dire consequences for both states’ budgets and their residents’ health.
Following the passage of HR1, Massachusetts state legislators originally proposed a $1,000 cap for dental benefits, which alarmed oral health providers and advocates. According to Dr. Prasad, over 25% of her patients’ care exceeded that cap — meaning they would be responsible for any costs over that amount. A new proposal from the state House of Representatives raised the proposed cap to $1,750.
But the proposed cap is missing a critical piece: 15 other states currently cap dental benefits, but often with exemptions for specific kinds of care or procedures. Chief among these is dentures, which Prasad describes as “the light at the end of the tunnel” for many of her patients, who sometimes require invasive treatments and full-mouth extractions. While $1,750 is right around the typical cost for two arches of dentures, according to Prasad, most patients would need extensive care prior to receiving dentures, and would be on the hook for the cost if dentures are not granted an exemption — and she fears that many would not want to move forward with their treatment without the guarantee of coverage for dentures.
“Dentures restore someone’s dignity, allow them to eat again without pain, enable patients to go to job interviews, reconnect with their families,” Prasad told TPM. There is currently no proposed exemption to allow Medicaid participants full coverage for dentures in Massachusetts, and MassHealth only covers dentures every seven years.
