Authors: Madeline Steward, Center for Health Care Strategies

Individuals with diabetes are significantly more likely to experience periodontal disease (or advanced gum disease), which can worsen glycemic control and increase disease complications. Evidence shows that improving oral health can, in turn, improve diabetes outcomes. Despite this connection, oral health and diabetes remain structurally disconnected in Medicaid. Medical and dental services are typically financed, delivered, and assessed separately, limiting coordination across providers and leading to missed opportunities to improve outcomes for individuals with diabetes.

For Medicaid programs, this fragmentation represents both a clinical challenge and a policy opportunity. Medicaid enrollees are disproportionately impacted by diabetes and more likely to experience unmet oral health needs, yet Medicaid dental benefits and care coordination strategies vary widely by state. Medical-dental integration models offer promising approaches to improve outcomes, enhance patient experience, and reduce costs.

What is medical-dental integration?

Medical-dental integration refers to the coordination of oral health and medical care to more holistically address patients’ needs. For diabetes, integration can take many forms, including:

  • Early identification of risk, including screening for undiagnosed diabetes or fluctuating blood glucose levels in dental settings and referring patients to appropriate medical care;
  • Coordinated disease management, particularly linking periodontal treatment with diabetes care through shared care plans and bidirectional referral pathways;
  • Co-location of services, such as embedding dental providers in primary care settings (or vice versa) to improve access, enable warm handoffs, and facilitate real-time coordination;
  • Data interoperability, including shared electronic health records or bi-directional information exchange that allows providers to access clinical information, track referrals, and coordinate care across settings;
  • Payment strategies, such as value-based payment models and aligned incentives that support integration and encourage collaboration across medical and dental providers; and
  • Shared accountability across providers, increasingly reinforced through quality measurement and performance metrics that track integrated care delivery.

These approaches recognize that oral health is not separate from overall health, but rather an essential component of effective chronic disease management. Within diabetes care, the American Diabetes Association emphasizes the importance of integrating dental professions into the diabetes care team and highlights the need for regular coordination with medical professions on early detection, medication management, and treatment plans, among other activities, as the standard of care for people with diabetes.

What is the policy landscape in Medicaid for medical-dental integration?

States are increasingly using policy levers to support integration, including expanding adult dental benefits, incorporating oral health requirements into medical managed care contracts, and using delivery system reform initiatives to incentivize coordination across providers. States are also testing ways to incorporate dental services into value-based payment arrangements, support co-location of services in safety-net settings, and strengthen data-sharing infrastructure to enhance care coordination.

This momentum is also reflected at the federal level. The Centers for Disease Control and Prevention has funded state and national partner efforts to integrate oral health and chronic disease programs, including initiatives to embed diabetes screening and referral into dental settings and improve care coordination. Quality measurement is also evolving to better reflect integrated care. The Dental Quality Alliance’s “Adults with Diabetes – Oral Evaluation” measure is included as a voluntary measure in the 2027 Medicaid Adult Core Set, signaling growing national alignment around integrated care.

What is the evidence behind medical-dental integration for individuals with diabetes?

A growing body of evidence demonstrates that improving oral health can contribute to better diabetes outcomes, particularly through the treatment of periodontal disease. Dental settings can also play an important role in identifying individuals at risk for or living with diabetes. Integrated models that incorporate screening, risk assessment, and referral pathways can improve early detection and engagement in care and result in cost-savings. Relevant studies include:

What does medical-dental integration for individuals with diabetes look like in practice?

The following resources offer insights into how medical-dental integration approaches are designed and implemented:

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