Skip to main content
U.S. flag

An official website of the United States government

NCD report finds a return on investment for offering Medicaid dental care for adults with I/DD

Wednesday, March 9, 2022


March 9, 2022

WASHINGTON—Today the National Council on Disability releases the results of a preliminary Medicaid study focused on the costs and return on costs of offering basic dental benefits to adults with intellectual and developmental (I/DD).

Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis provides the initial results of NCD’s ongoing research and recommendations into how to improve oral health outcomes for people with I/DD, showing the cost effectiveness of adding basic dental benefits in the 12 states that currently do not offer them.

This report was motivated by a central research question: should the Centers for Medicare and Medicaid Services require all state Medicaid agencies to implement Medicaid reimbursement and payment policies that promote access to dental care for adults with I/DD. Medicaid adult dental benefits vary widely by state and limited research exists on how the Medicaid program should best address oral health disparities for adults with I/DD.

“Given that dental health is a predicate for general health, and general health is a predicate for employment, education, and community life, we want to offer policymakers insights into how they can help improve oral health outcomes for people with I/DD,” said NCD Vice Chair Jim Brett. “With over a quarter of a million adults with I/DD who receive Medicaid living in states with either emergency-only or no dental coverage,  and two-thirds of adults with I/DD on Medicaid living in states that have extensive benefits still not receiving basic dental care, this initial study begins an important examination of access barriers.”

The report examined:

  • The relationship between states’ Medicaid dental benefits and the receipt of basic dental care among adults with I/DD;
  • The relationship between state waiver and receipt of dental care;
  • Estimated cost and potential savings of implementing basic dental Medicaid benefits in states that do not currently offer it;
  • How coordination between DD and Medicaid agencies can improve access to dental care; and
  •  Promising Medicaid-funded state and private strategies for expanding dental care for adults with I/DD.

Poor oral health often leads to chronic disease, it also increases the likelihood of experiencing poor physical health.

“Diabetes, cardiovascular disease, dementia, lung cancer, and many other serious health conditions are associated with preventable oral health conditions,” said NCD Council Member Rick Rader, M.D. “In states that provide no dental care in their Medicaid plans, a significantly higher proportion of dental care is provided in emergency departments, driving up costs and not necessarily even addressing the preventable health concerns that come with this type of reactive health care.”

Key findings include:

  • Of the nearly 7.3 million adults with I/DD in America, nearly 4.5 million rely on Medicaid for health coverage.
  • Medicaid does not uniformly provide adults with I/DD dental coverage and 12 states do not provide basic dental benefits aside from limited waiver programs in seven of them.
  • Adults with I/DD in those states are often foregoing preventative and routine dental care and seeking emergency dental care at much higher cost, and/or developing chronic health conditions.
  • Adults with I/DD ages 18 and older experience poorer oral health and significant barriers to obtaining oral health care, relative to adults without I/DD.
  • NCD’s estimates federal and state governments combined would realize a ROI of approximately $7.7 million beyond recovering the initial cost, annually, and the share of that ROI for those 12 states would total close to $3 million, annually.
  • NCD estimates an overall modest ROI for providing basic dental coverage for adults with I/DD in those states that provide emergency-only or no coverage ranging from an increased cost of $60,358 in Nevada to as much savings as $829,803 in Maryland – with costs likely offset by eliminating costly trips to the emergency room.

Key recommendations include:

  • States should add dental benefits for adults with I/DD to their 1915(c) and 1915(i) waivers or 1115 demonstrations and may want to refer to those states that currently extend dental coverage to adults with I/DD as a model.
  • States should consider available data about and evaluations of these waiver programs to prioritize the types of dental services and target populations to include in their own waivers. States can use available data as guidance to maximize access to key, cost-effective dental services while balancing available funding.
  • States should fund programs that address the additional barriers to obtaining oral health care through Medicaid, including incentivizing the dental workforce to attract providers with expertise in treating adults with I/DD through continuing education programs, implementing programs that improve daily oral care provided by caregivers, and improving education and support for good oral hygiene for adults with I/DD.
  • States should address transportation barriers and coordinate services between DD agencies and Medicaid providers.
  • The U.S. Department of Health and Human Services, through the Administration on Community Living, should conduct additional research to help reduce the need for the receipt of dental care in the operating room.

NCD’s ongoing research on this topic will examine why providers choose not to participate in Medicaid programs and waivers that facilitate the treatment of patients with I/DD and potential incentives to encourage participation.

NCD is an independent, nonpartisan federal agency that advises the President, Congress and other federal agencies on disability policy.

NCD has worked on oral healthcare issues and includes it in the new Health Equity Framework document released last month. In 2017, NCD published Neglected for Too Long: Dental Care for People with Intellectual and Developmental Disabilities, and in 2019 made recommendations leading to a change in policy requiring all U.S. dental schools to train students to manage treatment of people with intellectual, developmental disabilities.

The report is available at




An official website of the National Council on Disability