Expanded Medicaid dental benefits are working, but statistics show oral health access in rural communities is lacking

When Missouri expanded Medicaid dental benefits this summer, advocates hailed it as a breakthrough. For the first time, adult Medicaid recipients could receive routine dental exams—a service long excluded from the program. Although some dental offices across the state began accepting Medicaid patients right away under the new reimbursement system, there are still many rural counties where dental care access is paltry due in large part to a lack of providers.

The Numbers

National surveys place Missouri in the bottom tier when it comes to preventive care. According to America’s Health Rankings, only about 61 percent of Missouri adults visited a dentist in the past year, placing the state 37th out of the 50 states. Among children, the situation is even more dire: Just 74.9 percent had a preventive dental visit in 2022–23, ranking Missouri 47th out of 50 states.

For low-income children, the gaps are even starker. The Missouri Coalition for Oral Health reports that 63 percent of Medicaid-enrolled kids received no dental care at all in the last year. At the same time, Missouri is one of just four states without a school-based dental sealant program, a preventive measure proven to reduce cavities. The Pew Charitable Trusts gave Missouri a “C” for children’s oral health and a “D” for use of sealants.

Medicaid’s Expanding Reach

For decades, Missouri Medicaid reimbursed dentists at rates that barely covered costs, which discouraged many providers from participating. That changed in 2022, when the state boosted reimbursement to 80 percent of market rates, up from about 30 percent, according to Missouri’s Department of Health and Senior Services. This policy shift has brought some new providers into the program, but coverage gaps remain, especially in rural areas.

And even with routine exams now covered for adults through Medicaid, many high-cost procedures like crowns, bridges and dentures are still left out. Advocates argue that without comprehensive coverage, patients will continue to delay or forgo care.

Missouri’s Dental Workforce

According to data compiled by Becker’s Dental Review, Missouri is home to about 3,520 dental hygienists and 3,035 dentists. With a statewide population of roughly 6.17 million people, according to Data USA, the ratios paint a clear picture of access: about one dental hygienist for every 1,750 Missourians and one dentist for every 2,030 residents.

These ratios matter. They not only reflect how many professionals are available to deliver care but also hint at the pressures facing both patients and providers. In rural counties, where dentists are fewer and farther between, the ratios can stretch even thinner, making preventive care less accessible. By contrast, metropolitan hubs like Kansas City see higher concentrations of providers, creating disparities between urban and rural residents.

Nationally, Missouri’s numbers fall just shy of the ideal benchmarks set by organizations like the Health Resources and Services Administration, which suggests that healthier oral outcomes depend on more evenly distributed care. Still, the state’s nearly one-to-one balance between dentists and hygienists is notable. Hygienists often form the backbone of preventive services, freeing up dentists to handle restorative and specialized treatments. 

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