Medicaid in North Carolina: What Budget Cuts Could Mean for Oral Health 

by | Oct 29, 2025

Background

In 2023, North Carolina took a historic step forward by expanding Medicaid. Hundreds of thousands of North Carolinians gained access to care that had long been out of reach, including dental benefits. Expansion opened the door to preventive care, routine visits, and treatment that could finally help close longstanding gaps in oral health access. Within the first two months, NCDHHS reported over $2.4 million in claims for dental services.

But just two years later, Medicaid in North Carolina stands at a crossroads. Budget cuts and stagnant reimbursement rates are threatening the progress made through expansion. For dentists who already struggle under low Medicaid payment rates, these cuts could make continued participation financially unsustainable. And for patients, the consequences could be severe: longer wait times, fewer providers, and worsening oral health outcomes.

The New Challenge: Rate Cuts and Budget Shortfalls

Beginning on October 1, 2025, the state implemented a 3 percent across-the-board cut to Medicaid provider reimbursements. For some services, the cuts are even deeper.

On the surface, a 3 percent reduction may not sound like much. But for dental providers already operating on thin margins, it’s significant. Medicaid dental reimbursement rates in North Carolina have not been updated since 2008 and currently cover only about 35 cents of every dollar charged.

What This Means for Dental Providers

Many providers who currently serve Medicaid patients already do so at a financial loss, absorbing the gap between reimbursement and the true cost of delivering care.

With rates dropping further, more dentists are expected to stop taking new Medicaid enrollees, reduce the number of Medicaid patients they see, or drop out of the program altogether. Smaller practices or rural providers are especially vulnerable, as their financial buffers are even thinner.

Adding to the strain, new administrative and credentialing requirements are on the horizon. While oversight and accountability are important, additional paperwork and delays can create yet another barrier for practices deciding whether to remain in the program.

Impacts on Patients and Communities

The ripple effects of provider withdrawal will be felt most acutely by patients.

  • Fewer Providers, Longer Waits: With fewer dentists participating, patients will face longer waits for appointments and may have to travel farther to find care. In some rural counties, access could disappear altogether.
  • Loss of Preventive Care: Preventive visits, cleanings, and early interventions are the first services to decline when access shrinks. Without them, small issues can progress into infections, extractions, and tooth loss.
  • Emergency Department Use: As preventive access declines, more people will turn to emergency departments for dental pain. While they provide temporary relief, these visits do not address underlying conditions, and they are more costly for the health system.
  • Widening Health Gaps: The consequences will fall hardest on low-income families, children, and communities of color, who already experience disproportionately high rates of untreated dental disease.

What’s Next?

Less than half of North Carolina dentists accept any Medicaid patients. Of those, many accept just a few and most are not currently accepting anyone new. The planned reimbursement reductions further divide those who can afford private care from those who cannot.

One promising effort to address North Carolina’s long-standing dental reimbursement gap is House Bill 60, introduced earlier in 2025. The bill proposed raising Medicaid dental reimbursement rates from 35 to about 46 cents on the dollar. While not on par with commercial insurance, this increase would move North Carolina closer to neighboring states and make it more financially feasible for dentists to participate in Medicaid.

HB 60 has not yet passed. However its introduction highlights the growing recognition among policymakers that current reimbursement rates are insufficient. Improving reimbursement is essential to preserve access to oral health care for Medicaid enrollees.

Oral health is inseparable from overall health. Untreated dental diseases affect nutrition, school and work attendance, and even chronic conditions like diabetes and cardiac health. When access to dental care is lost, the consequences ripple across entire communities.

If you are a patient, provider, or advocate, your voice matters. Share your story, talk to your legislators, and join NCOHC in our mission to ensure that every North Carolinian can access the oral health care they need and deserve.