Rural communities face persistent — and often widening — oral health disparities compared to urban and suburban populations. While these access gaps are well-documented, they are not inevitable. Medicaid, which covers a disproportionate share of rural residents, offers powerful levers to expand oral health access and improve outcomes. This blog post explores how new investments, particularly the Rural Health Transformation Program (RHTP), create a critical window for states to accelerate progress through workforce expansion, care delivery innovation, and community-based models that better reach rural populations.

Rural Oral Health Disparities Persist

Rural communities face a range of overlapping structural barriers that constrain access to oral health care. Some of these challenges include:

• Chronic workforce shortages. As of April 2026, 67 percent of all Dental Health Professional Shortage Areas (HPSAs) were in rural areas, yet only 14 percent of dentists practice there. Access to dental specialists is even more limited, with more than 98 percent practicing in urban areas. The rural dental workforce is older on average than its urban counterpart, reflecting historic recruitment challenges and raising concerns about worsening shortages as providers retire. Low Medicaid participation among dental providers further limits access for rural residents who rely on Medicaid coverage.
• Geographic isolation and transportation challenges. Rural residents often lack access to public transit and must travel long distances to reach care, particularly specialty services. These challenges are especially acute for Medicaid enrollees, who are more likely to lack reliable transportation and less likely to have nearby providers who accept their coverage. These constraints contribute to delayed or forgone oral health care and persistent disparities in outcomes.
• Limited Medicaid coverage. Adult dental benefits in Medicaid vary widely by state, and in some states remain limited or restricted to emergency services. These gaps can contribute to delayed care and greater reliance on emergency departments, particularly in rural areas with few alternative options.
• Gaps in population-level oral health prevention. Rural communities are less likely to benefit from population-based oral health strategies. For instance, more rural households rely on private wells or small water systems that do not provide fluoridated water, limiting access to one of the most effective, low-cost tools for preventing tooth decay. These gaps are particularly consequential for Medicaid enrollees, who are less likely to access regular preventive dental care and may rely more on community-based prevention.

These challenges underscore the need for policy and delivery system strategies that expand who can deliver care — and where. Many Medicaid programs and their partners are already advancing approaches to expand access in rural communities.

Expanding Who Can Deliver Care — and Where

Expanding access in rural communities requires enabling oral health professionals to practice at the top of their license and provide care in a broader range of settings. Many are trained to deliver essential services but face policy and payment barriers. States can pursue strategies such as:

• Expanding the use of dental therapists. Dental therapists are mid-level providers trained to deliver preventive services (e.g., cleanings and sealants) and routine restorative care (e.g., fillings) under the dentist supervision. States are using this model in different ways to target communities with the greatest access challenges. In Minnesota, state law requires dental therapists to primarily serve low-income, uninsured, and underserved populations or practice in Dental Health Professional Shortage Areas, helping to target care to rural areas where access gaps are greatest.
• Enabling direct access for dental hygienists. States are increasingly allowing dental hygienists to deliver preventive services (e.g., screenings, cleanings, fluoride varnish, and sealants) outside traditional dental offices without prior dentist authorization. This expands access by bringing care closer to where people live and supporting earlier intervention. As of October 2025, 42 states allow some form of direct access for hygienists, but requirements vary.
• Integrating oral health into primary care settings. Medical-dental integration allows primary care providers to deliver basic preventive oral health services during routine visits — a key strategy where dental providers are scarce. In Ohio, the MORE Care model supports pediatric providers in incorporating oral health screenings, fluoride varnish, and patient education into well-child visits, while establishing referral relationships with dental providers and using payment to incentivize provider collaboration. Early results show increased preventive care and stronger referral pathways.

While expanding the workforce is essential, it does not fully address the geographic barriers that define rural access challenges — underscoring a need for models that extend provider reach beyond traditional settings.

Leveraging Teledentistry to Widen Patient Reach

Teledentistry is an increasingly important strategy for improving access to oral health care in rural communities, including for Medicaid populations. As of 2020, at least 20 state Medicaid programs reimbursed for teledentistry, and adoption continues to grow as states expand virtual care. By allowing dental teams to deliver preventive services in community settings and connect patients to dentists for remote diagnosis and treatment planning — as in California’s Virtual Dental Home model — teledentistry extends the provider reach and reduces delays in care.

While models vary by state, most teledentistry approaches bring care into community settings, where a provider — often a dental hygienist — delivers preventive services and conducts screenings. During the visit, diagnostic information is collected and shared with a dentist, who provides a remote assessment and develops a care plan, determining what can be treated onsite versus referred for follow-up. This coordinated model helps extend provider reach, reduce delays in care, and support continuity for patients.

This model allows scarce dental expertise to be shared across distances, enabling earlier intervention while reducing the need for travel — one of the most persistent barriers in rural communities.

Investing in Rural Health Workforce Training and Pipelines

Expanding access through community-based care and teledentistry is critical, but improving oral health in rural communities ultimately depends on a strong and sustainable workforce. Key investments can include:

• Building workforce capacity through community-based learning models. Initiatives such as the American Institute on Disparities in Public Health’s ROOTED program (formally Rural Oral Health Project ECHO), connect providers, public health professionals, and community partners through virtual learning collaboratives focused on rural oral health. These models build skills and confidence through peer-to-peer learning, mentorship, and dissemination of best practices.
• Expanding rural clinical training opportunities. State and academic institutions are investing in programs that prepare providers for rural and underserved settings. For example, in North Carolina, the East Carolina University School of Dental Medicine operates community-based training sites in rural and underserved counties, where students complete clinical rotations serving Medicaid populations. These programs expose future providers to rural practice and help build a workforce pipeline aligned with areas of greatest need.
• Supporting new provider pathways that reflect community needs. States are investing in strategies to encourage individuals from rural communities to pursue oral health careers, often through partnerships with schools and/or Area Health Education Centers. For example, the University of Alabama’s Rural Dental Health Scholars program provides mentorship, academic support, and dental career exploration for high school students.
• Expanding loan repayment and financial incentives tied to Medicaid participation. State and federal programs can help attract providers to rural areas, particularly when linked to service commitments in Medicaid or other safety-net settings. The National Health Service Corps Loan Repayment Program provides incentives for dentists to practice in HPSAs, many of which are rural and serve many Medicaid patients. States build on this approach through their own programs. For example, Virginia offers loan repayment for dental professionals in return for a minimum two-year service at an eligible practice site within an HPSA.
• Investing in retention and practice sustainability. Retaining providers requires ongoing support, including competitive Medicaid reimbursement, streamlined administrative processes, continuing education, and opportunities to practice at the top of licensure. States can further support retention by reducing barriers to participation in Medicaid and ensuring that payment and delivery models make rural practice financially viable.

Bringing It All Together

Improving oral health in rural communities requires more than a single intervention. States making the most progress are layering multiple strategies to address workforce shortages, geographic barriers, and prevention gaps. With targeted investments through RHTP and continued Medicaid innovation, states have a timely opportunity to build on these approaches and ensure that rural communities can access the oral health care they need.