Fragmented Medicaid coverage coupled with the lack of a dental benefit under traditional Medicare leads to poor oral health outcomes for older adults in nursing homes. Staffing shortages and rural access issues compound the problem.
This is the conclusion of an issue brief from Justice in Aging, a national organization focused on helping seniors from marginalized populations age with dignity and without financial worries. The organization has been advocating for a Medicare Part B oral health benefit since 2016.
Federal law requires nursing homes to evaluate dental health and provide access to care for residents, explains the brief. A new resident’s oral health should be evaluated upon intake and then on a quarterly basis. Facilities are also supposed to provide support with basic oral hygiene.
However, nursing home staff aren’t usually trained in dentistry and many providers lack the resources to provide training in more basic oral health, according to the brief. Staffing shortages also mean residents with limited mobility may not receive assistance with basic oral care, such as tooth brushing and flossing. Also, staff may not have time to assist in setting up dental appointments or providing transportation to appointments.
Many facilities lack a space to provide dental exams and treatment. In both rural and urban facilities, there is a shortage of dentists who will travel to the facility to provide care.
Lack of coverage part of problem
There is a strong correlation between oral health and other conditions, yet traditional Medicare lacks coverage for most dental services. The Centers for Medicare & Medicaid Services (CMS) has expanded coverage in recent years to include medically necessary dental services and dental services related to certain surgeries or conditions, such as oral cancer.
Low income older adults are also eligible for Medicaid, but under federal law, states aren’t required to provide dental coverage for adults. Eight states provide emergency coverage only, while 14 states provide limited coverage. While half of states provide more extensive adult dental benefits, there is variability in terms of what services are covered. This may change as states manage cuts to Medicaid funding implemented in the One Big Beautiful Bill Act, warns the brief.
Disparities in oral health
Nursing home residents present with poorer oral health than older adults in the community, according to the issue brief, which detailed recent research that found 30% of senior nursing home residents, regardless of insurance, had untreated tooth decay compared to 18% of seniors in the community. Around 27% of seniors in nursing homes had lost all their teeth, compared to 11% of people in the community. Further, residents in rural areas were 13% more likely to have tooth decay. Residents in rural facilities were also 70% more likely to have multiple dental issues than their urban counterparts.
Additional disparities exist when broken down by race. Black residents were 16% more likely to have no natural teeth than white residents, while American Indian or Alaskan Native residents were 34% more likely than white residents.
Chronic conditions can make oral health worse or can be impacted by poor oral health, said the brief. Those residents who have three or more chronic conditions experience the worst oral health outcomes. Alzheimer’s patients are particularly at risk for decreased oral health.
Proposed solutions
Justice in Aging examined several initiatives that have shown promise in improving oral health for nursing home residents. Tele-denistry allows providers to connect with patients via video, which can lead to addressing problems sooner. Expanding the scope of practice for dental hygienists and allowing them to work with dental therapists and community health workers can also help with access in rural areas. California has such a program that has shown improvement in oral health access.
Another possible solution is the medical dental integration model, which promotes a one-stop-shop approach to health care. This is done by either having dentists and medical doctors in the same community health clinic or by training primary care doctors to provide basic preventative services.
These services currently aren’t possible without a Medicare Part B dentistry benefit providing coverage, said Justice in Aging. Two bills have been introduced to create such a benefit – H.R.2045 – Medicare Dental, Vision, and Hearing Benefit Act of 2025 and S.939 – Medicare Dental, Hearing, and Vision Expansion Act of 2025 – but the House bill died on the floor and the Senate bill is still in committee.
The organization calls for stakeholders to address the challenges beyond coverage to ameliorate the disparities in access and outcomes.
