Access to oral health care is a critical component of overall health, yet many Medicaid enrollees face challenges in securing services due to longstanding provider shortages across the country. About 20 percent of Americans reside in dental health professional shortage areas.⁵ Within Medicaid, dental provider engagement has remained largely stagnant. As of 2024, only about 41 percent of dentists participate in Medicaid or CHIP — roughly the same share as a decade ago, despite many states enhancing Medicaid adult dental benefits in recent years.^6,7 Without a robust Medicaid oral health workforce, people seeking care face difficulties and delays in accessing basic oral health care.⁸ Medicaid members who are unable to access routine oral health care services are also more likely to end up seeking care in a more costly emergency setting — where providers are not as well equipped to adequately address and treat their needs.⁹

Like many states across the country, Missouri has faced dental provider recruitment and retention challenges that resulted in difficulties accessing care, including long wait times for appointments for Medicaid members.¹⁰ Recognizing the gap and its impact on oral health, the Missouri Coalition for Oral Health (MCOH), MO HealthNet Division (MHD, the state’s Medicaid program), and the Missouri Dental Association (MDA) partnered to strengthen the state’s Medicaid dental provider network. This case study highlights their strategies to increase the number of Medicaid-enrolled dental providers by improving administrative processes, reimbursement, communication, and provider support. This case study is a product of the Medicaid Oral Health Workforce Implementation Learning Series, led by the Center for Health Care Strategies (CHCS) through support from CareQuest Institute for Oral Health.

Approach to Addressing Dental Provider Shortage

MCOH, MHD, and MDA partnered to develop a coordinated approach to increase access to dental care for Missourians. Their collaborative efforts, supported in part by grant funding from the Missouri Foundation for Health, Delta Dental of Missouri, and the Health Forward Foundation, have substantially increased dentist enrollment and participation in MO HealthNet. By sharing provider recruitment and retention responsibilities, the collaboration has also enabled MHD to dedicate more time to updating and streamlining policies and systems, engaging in reporting and data analysis, expanding available resources and trainings, and coordinating changes with managed care plans. Since its formation in June 2022, the partnership has implemented a series of comprehensive, aligned strategies to strengthen MO HealthNet’s dental network, including:

• Increasing MO HealthNet dental reimbursement rates to align with commercial payers, strengthening the states’ ability to attract new providers. MDA and MCOH advocated for rate increases, and in July 2022, the legislature approved an increase of dental reimbursement rates to 80 percent of the 50^th percentile of the National Dental Advisory Service (NDAS) comprehensive fee report. This increased rates from 38.5 percent to approximately 80 percent usual and customary reimbursement (UCR) — the largest dental rate increase in the state’s history.¹¹ MHD considered a variety of factors and consulted with various experts, including the state’s dental director, dental consultant, and dental providers, to determine which codes should receive increases, with many of the selected codes focused on preventive care.¹²
• Creating a new role — the Dental Medicaid Facilitator — within MCOH to support dental providers navigating MO HealthNet processes. Created in November 2022, the facilitator — in close collaboration with MHD and MDA — engages in activities to recruit providers, streamline provider enrollment, address operational barriers, and reduce provider frustration. The facilitator also connects with and creates resources to help providers navigate MO HealthNet enrollment, credentialing, claims, and compliance. For example, MCOH developed 30-minute webinars on integrating Medicaid into dental practices, working with the state’s fee-for-service (FFS) arm and managed care plans, credentialing, coding, and more.¹³
• Launching a media campaign to dispel misconceptions, share resources and policy information, and strengthen communication with providers. The MO Medicaid Matters campaign launched in April 2023 and has reached thousands of dental students and providers across the state.¹⁴ To facilitate engagement, the campaign uses online banner ads, social media posts, and both electronic and traditional mail to direct providers to MCOH’s website and to the Dental Medicaid Facilitator. The collaborative uses consistent messaging in all provider communications.
• Enhancing reimbursement rates for additional services and expanding dental benefits for MO HealthNet members. In July 2024, MHD increased rates for dental extractions and anesthesia.¹⁵ The agency also expanded access to periodic exams for adults previously not covered under MO HealthNet and expanded eligibility to silver diamine fluoride for beneficiaries age 20 years and younger, as well as those who are pregnant, blind, or residing in skilled nursing facilities.¹⁶

Impact of Missouri’s Dental Access Partnership

The collaboration between MCOH, MHD, and MDA has produced measurable improvements (see the table below). Over the last four years, dentist participation in MO HealthNet increased from 34 to 44 percent. Because providers regularly cycle into and out of MO HealthNet, MHD tracked both the total number of participating dentists and newly enrolled dentists. Between 2022 and 2026, they observed a total of 846 new MO HealthNet dentists — a net increase of 423 dentists. The partnership’s provider-focused strategies also increased service utilization. In 2025, almost 34 percent of MO HealthNet beneficiaries accessed dental services, up from about 24 percent in 2022. Geographically, the number of counties without any dental providers decreased from 36 in 2022 to 17 in 2024.¹⁷

*As of 2/24/26
**These providers billed MO HealthNet for services rendered.
***Increases were split evenly between adults and children.

Recommendations for Other States

Missouri’s experience offers several lessons for states seeking to strengthen their Medicaid oral health workforce and improve access to services, such as:

• Review reimbursement rates to determine which increases could have the greatest impact on access and provider participation. Missouri’s previous rate of 38.5 percent UCR contributed to low provider enrollment, and dentists who participated in MO HealthNet at those rates were often operating at a loss when treating MO HealthNet patients. Nationally, Medicaid FFS reimbursement for dental services averages between 64 percent (adult services) and 67 percent (child services) of what private insurance pays. In contrast, MO HealthNet’s current average reimbursement is 105 percent of private insurance for child dental services and 122 percent for adult services. While rate increases alone cannot fully address provider enrollment or access challenges, they are a necessary and influential tool for attracting new providers and retaining the existing network.¹⁸
• Encourage providers to talk with peers about their experience with MO HealthNet. Hearing from colleagues who have had positive experiences with the Medicaid program can influence providers’ perceptions of what it is like to participate. MDA plays an important role in this work — their support enables buy‑in from the provider community. During weekly touch base meetings, MDA shares information with MCOH and MHD on dental provider perspectives and legislative priorities. In Missouri, the state uses a feedback loop between MDA, MCOH, and MHD to better understand provider experiences and respond to emerging issues with MO HealthNet. The MO Medicaid Matters campaign also features conversations with providers, including this 45-second video interview with Arrash Ahmadnia, DDS, discussing his experience as a Medicaid provider. MDA provides the contact list for this campaign, ensuring that they reach all dental providers.
• Build and support connections with external organizations, such as dental schools, to strengthen outreach and collaboration opportunities. To reach dentists-in-training and newly accredited dentists, the partners recommend forming strong relationships with external organizations, such as the state’s dental schools, to encourage students to become Medicaid providers. Nationally, Medicaid and CHIP participation is highest among early-career dentists and those ages 21 to 34, making these partnerships especially valuable.¹⁹
• Leverage claims data to get an accurate understanding of provider engagement and service utilization. Regularly measuring and analyzing data is instrumental for tracking progress, but understanding the context behind the data is equally important when assessing impact and mapping next steps. Missouri relies on many different types of data to fully understand the provider and patient landscape. For example, the state examines not only provider enrollment but also the number of providers performing services, since enrollment alone does not guarantee participation in MO HealthNet. In 2024, 926 of 1,199 dentists enrolled in MO HealthNet billed for services — an increase from 743 providers in 2022.²⁰ While this growth suggests progress, it also highlights opportunities to focus on retention and to engage non-participating providers to understand barriers to participation.
• Involve managed care plans in ongoing discussions to ensure alignment. Missouri administers dental benefits through both FFS and three managed care plans. When changes are made to FFS, MHD communicates these updates to the managed care plans to ensure they are mindful of new requirements. Strong connections between the collaborative partners and the health plans help surface and resolve provider challenges related to enrollment, credentialing, billing, or communication across all three plans — not just FFS. To support provider participation in both FFS and managed care, the partners develop resources and opportunities for engagement. In 2024, MHD hosted a dental billing and policy workshop, which included time for each plan to walk through its processes.²¹ Additionally, by working directly with each plan’s dental network, MHD can more effectively reach and support enrolled providers.

Missouri’s experience shows how sustained collaboration, financial investment, targeted policy updates, and provider‑focused support can meaningfully strengthen a state’s Medicaid dental network. Their collaboration highlights the value of cross‑sector partnership and coordinated system improvements in strengthening the Medicaid oral health workforce. Missouri’s work offers useful guidance for states seeking to enhance provider engagement and ensure that more Medicaid members can access dental services.

1. U.S. Census Bureau. (2024). QuickFacts: Missouri. https://www.census.gov/quickfacts/fact/table/MO/PST045224
2. Centers for Medicare & Medicaid Services. (2025, October). November 2025 Medicaid & CHIP enrollment data highlights. Medicaid.gov. https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/october-2025-medicaid-chip-enrollment-data-highlights
3. MO HealthNet. (2025, December). Dental benefit table. Missouri Department of Social Services. https://mydss.mo.gov/media/pdf/dental-benefit-table
4. Emmerich, J. & Fahrendorf, A. (2026, January 29). [Private presentation to Medicaid Oral Health Workforce Implementation Learning Series participants].
5. HRSA Data Warehouse. (2026, March). Health workforce shortages areas [Data dashboard]. https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard
6. American Dental Association. (2025, December). Dental care in Medicaid programs [Presentation]. Health Policy Institute. https://www.ada.org/-/media/project/ada-organization/ada/adaorg/files/resources/research/hpi/dental_care_in_Medicaid_programs.pdf 
7. CareQuest Institute for Oral Health. (2025, August 1). Medicaid Adult Dental Coverage Checker [Data dashboard]. https://carequest.org/medicaid-adult-dental-coverage-checker/
8. Rahman, M.S., Blossom, J.C., Kawachi, I., Tipirneni, R., & Elani, H.W. (2024, December). Dental clinic deserts in the US: spatial accessibility analysis. JAMA Network Open, 7(12), e2451625. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828397
9. American Dental Association. (n.d.). Emergency department referrals. https://www.ada.org/resources/community-initiatives/action-for-dental-health/emergency-department-referrals
10. Harbison, G. (2024, May). Increasing access to Medicaid dental – Missouri oral health policy & system change [Presentation]. Missouri Coalition for Oral Health. https://scaany.org/wp-content/uploads/2024/05/WB4_Increasing-Access-to-Medicaid-Dental_MCOH.pdf
11. Missouri Department of Social Services. (2022, July 29). Rate update for dental services [Provider bulletin]. https://mydss.mo.gov/media/pdf/rate-update-dental-services
12. Harbison, G. (2024, May).
13. Missouri Coalition for Oral Health. (2024). Medicaid-mini series. https://www.oralhealthmissouri.org/medicaid-mini-series
14. Missouri Coalition for Oral Health. (2024). Capturing the moment 2024. https://www.oralhealthmissouri.org/images/832/document/capturing-the-moment-2024-mcoh-je-sd_1960.pdf
15. Missouri Department of Social Services. (2024, June 28). Public notice of rate increases for fiscal year 2025 for the Department of Social Services, MO HealthNet Division. https://mydss.mo.gov/media/pdf/public-notice-rate-increases-fiscal-year-2025-department-social-services-mo-healthnet
16. Missouri Department of Social Services. (2025, October 6). Updated MO HealthNet dental manual & webinar. https://mydss.mo.gov/mhd/hot-tips/updated-mo-healthnet-dental-manual-webinar
17. Emmerich, J. & Fahrendorf, A. (2026, January 29).
18. American Dental Association. (2025, December).
19. American Dental Association. (2025, December).
20. Emmerich, J. & Fahrendorf, A. (2026, January 29).
21. MO HealthNet (2024, March 11). Dental billing & policy workshop. Missouri Department of Social Services.  https://mydss.mo.gov/media/pdf/dental-agenda-3112024