"Variation in Use of Dental Services by Children and Adults Enrolled in Medicaid or CHIP"

This KFF study offers a comprehensive, data-driven view into how structural inequality shapes access to oral health care for individuals enrolled in Medicaid and CHIP. From an anthropological perspective, the findings reflect far more than policy inefficiencies. They reveal how systemic inequities, political marginalization, and social stratification converge to influence who receives care and who remains invisible in the healthcare system.

The sharp divide between dental coverage for children and adults is particularly revealing. While federal policy mandates dental benefits for children through the EPSDT requirement, adult dental coverage remains optional, resulting in uneven access across states. Anthropology helps contextualize this variation as a form of structural neglect, where adults in low-income communities are deprioritized, and oral health is positioned as a secondary concern rather than a fundamental component of overall well-being. This reflects a broader devaluation of poor and working-class adults in public health policy, where dental coverage becomes a litmus test for whose health is considered essential.

The data further show how racial and geographic disparities persist despite the promise of broad Medicaid coverage. Hispanic and Asian children have higher reported dental service use, but Native Hawaiian and Pacific Islander and American Indian and Alaska Native children have the lowest rates. This inequity cannot be understood without examining the long-term effects of settler colonialism, historical underfunding of Indian Health Services, and ongoing exclusion of Indigenous and Pacific Islander communities from mainstream care infrastructures. These findings align with anthropological research that highlights how racism and historical trauma are embedded in institutional design, leaving certain populations perennially underserved.

Geographic data also reveal consistent disparities in dental access between rural and urban residents. Anthropology recognizes this not simply as a matter of distance but as a spatial expression of inequality, where healthcare deserts reflect the uneven distribution of providers, transportation, and institutional resources. In rural communities, even those with Medicaid eligibility may find no dentist nearby who accepts it, reinforcing cycles of deferred care and poor health outcomes.

The study also highlights how preventive dental care is used less frequently than treatment-based care, especially among adults. This pattern is both a symptom and a consequence of structural barriers. Adults are more likely to seek dental services for emergencies or visible decay rather than for routine checkups or cleanings, not due to lack of education but due to constrained access and limited provider availability. Anthropology emphasizes that these choices are rational responses to constrained systems, not evidence of poor individual decision-making. The broader health system’s failure to integrate dental care into routine and preventive services reinforces a separation between oral and general health that disproportionately harms low-income and marginalized populations.

Moreover, the pandemic’s lasting effect on dental service utilization highlights how fragile access to care truly is for Medicaid enrollees. The decline in visits during 2020 and the slow rebound reflect not only logistical disruptions but also deeper fears, barriers, and unmet needs among populations already struggling to remain connected to care. Continuous enrollment policies, expansions of school-based dental care, and stronger EPSDT oversight may help reverse these trends, but anthropological analysis reminds us that policies must be matched with attention to cultural relevance, trust in care providers, and attention to lived experiences within specific communities.

This report makes visible how access to oral health care in the U.S. is deeply shaped by economic vulnerability, racial and geographic identity, and fragmented policy implementation. Anthropologists view these patterns as part of a larger structure of health inequity, one where oral health serves as both a reflection of and contributor to systemic marginalization. Addressing these disparities will require more than expanding benefits. It demands a rethinking of how care is delivered, where it is provided, and whose health needs are prioritized.

https://www.kff.org/medicaid/issue-brief/variation-in-use-of-dental-services-by-children-and-adults-enrolled-in-medicaid-or-chip/