JAMA Model Projects Pediatric Medicaid Cuts Would Add 95,799 Caries Cases, $86.5M Cost

Start Discussion
Posted: May 22, 2026

JAMA Model Projects Pediatric Medicaid Cuts Would Add 95,799 Caries Cases, $86.5M Cost

Edited by Dentaltown staff

Large-scale loss of pediatric Medicaid coverage under the 2025 One Big Beautiful Bill Act would be associated with worsening children’s oral health outcomes and higher health care costs over a 10-year period, according to a simulation modeling study published May 12 in JAMA Network Open.

In the base-case scenario, the study projected an additional 95,799 incident caries events, 7,367 additional emergency department visits for nontraumatic dental conditions, 27,084 quality-adjusted life-years lost, and $86.5 million in incremental health care costs nationally between 2025 and 2034. Per affected child, the model projected 0.21 additional caries events, a $187.6 increase in dental-related costs, and a 10.6% relative increase in dental-related health care costs compared with the status quo.

The researchers used a stochastic decision-analytic microsimulation model representing a nationally representative cohort of 100,000 U.S. children aged 0 to 18. Population characteristics were drawn from the National Health and Nutrition Examination Survey 2013–2018, the only national survey containing clinical oral health examination data rather than self-reported outcomes. The base-case exposure was a projected annual reduction of 480,000 children from Medicaid enrollment under OBBBA work-reporting requirements applied to expansion adults, with low- and high-impact scenarios assuming 263,000 and 803,000 fewer children enrolled, respectively.

Across the alternative policy impact scenarios, projected 10-year incremental caries events ranged from 54,051 to 161,231, incremental costs ranged from $47.9 million to $145.8 million, and QALY losses ranged from 15,143 to 45,410. Sensitivity analyses produced directionally consistent results.

Medicaid currently provides comprehensive pediatric dental coverage through the Early and Periodic Screening, Diagnostic, and Treatment benefit to approximately 37.3 million children and adolescents. The model assumed 21% of children losing Medicaid coverage would transition to the Children’s Health Insurance Program, with the remainder becoming uninsured. The authors noted that CHIP dental coverage is more limited than Medicaid in some states, particularly for restorative, endodontic, prosthodontic, and dental-related anesthesia services, meaning even transitions to CHIP could disrupt care continuity.

The study was led by Sung Eun Choi of the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology, with co-authors from Harvard and Brigham and Women’s Hospital. It was supported by the National Institute on Minority Health and Health Disparities and the Harvard School of Dental Medicine’s Initiative to Integrate Oral Health and Medicine.

In an accompanying invited commentary, Brandy J. Lipton of JAMA Network Open framed the findings within ongoing debates over children’s dental care access amid federal policy changes. The American Dental Association has flagged the analysis as evidence relevant to its advocacy on Medicaid policy.

Sources:
JAMA Network Open, “Projected Oral Health Outcomes and Costs Associated With Pediatric Medicaid Disenrollment,” by Sung Eun Choi, Lisa Simon, Catherine Hayes, William V. Giannobile, et al., May 12, 2026: jamanetwork.com/journals/jamanetworkopen/fullarticle/2848860
JAMA Network Open, “Protecting Children’s Dental Care Access Amid Policy Changes” (invited commentary), by Brandy J. Lipton, May 2026: jamanetwork.com/journals/jamanetworkopen/fullarticle/2848865
ADA News, “JAMA study projects pediatric Medicaid disenrollment would worsen oral health, raise health care costs,” May 21, 2026: adanews.ada.org/ada-news/2026/may/jama-study-projects-pediatric-medicaid-disenrollment
Views: 11
Start Discussion
Dentaltown Magazine
May 2026
Dentaltown Magazine May 2026 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
What’s actually driving most of your new patient flow right now?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Pods & Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
The Dentaltown Team, Farran Media Support
Phone: +1-480-445-9710
Email: support@dentaltown.com
©2026 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450