What Is The Medicaid Gap?


Each state organizes its own Medicaid program following federal guidelines, which means that eligibility requirements, reimbursement rates, and dentist involvement differ from state to state. Eligibility is determined by adapted adjusted gross income, but income limits vary.

Revenue is evaluated by comparing it to a proportion of the federal poverty line, which is determined yearly by the US State Department of Health and Human Services. In Wisconsin, for example, a single adult without kids is eligible for Medicaid if their annual income is well below the federal poverty level ($12,760 in 2020). The same adult, however, is ineligible for Medicaid in, Florida, Texas, Kansas, and 11 other states. As time passes,these rules have been restricted, thereby reducing the medicaid gap.

Medicaid Expansion Benefits
Under current Medicaid law, states have the option to include adult dental coverage. The new comprehensive health reform which started in 2014, will require Medicaid to increase all elements of coverage to residents with incomes up to 133% of the federal poverty level. With several more people gaining eligibility for adult Medicaid dental health benefits, this has generated a good number of elasticity demand for dental care. This is critical for allocating limited resources and making budget decisions. Here are the following Medicaid Expansion Benefits To Young Adults;

  1. Reduce the number of uninsured patients, as compared to what it was before.
  2. Reduce the number of young Black trauma patients who die in the hospital as a result of their injuries, bringing the percentage closer to that of White patients.
  3. Increasing the percentage of patients discharged to outpatient clinics where they can recover from their injuries under professional supervision.

Impact Of Dentist Use of Medicaid
According to the HPI, private health insurance firms in the United States refund dentists at 80% of billed charges, whereas Medicaid reimburses dentists at 49%, although that differs by state. Dentists in Kentucky earn more Medicaid funding than private pay, and yet only 28% are matched with Medicaid services. Medicaid pays more than 85% of what is billed to dentists in Nevada and West Virginia, but only 41% and 60% of dentists within these states partake in Medicaid, respectively.

Several Medicaid recipients have not seen a dentist in a long time, and a number of them may have cavities or other dental issues that need to be addressed and monitored. Finally, these issues have arisen as a result of a lack of knowledge about the benefits of being on Medicaid, along with a lack of dentists who accept Medicaid.

Increased awareness and understanding of Medicaid financing options and services may allow the proportion of dentists in the country embracing Medicaid to rise above the 38% currently accepted, according to the ADA. This could allow more dentists to endorse Medicaid and fulfill their pledge to provide care to the needy while boosting their financial situation. Overall, education is required for both the population and the dentists around the nation.


1. https://www.healthinsurance.org/faqs/what-is-the-medicaid-coverage-gap-and-who-does-it-affect/
2. https://www.sciencedirect.com/science/article/abs/pii/S016762961100110X
3. https://www.nimhd.nih.gov/news-events/research-spotlights/medicaid-expansion-benefits-young-adults.html

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Isabella Baxter

Written by Isabella Baxter

Expert in the medical industry. Writer | Blogger | Dreamer.