Where Dental Insurance Falls Short: Medicaid and CHIP Children Struggle to Find Specialist Care

A child may have dental insurance and still struggle to find the specialist needed to save a damaged tooth, treat a complicated jaw condition or correct a medically serious bite problem. The study, 'Prevalence and Availability of Specialty Dental Care Sites for Children Covered by Medicaid and CHIP in the United States,' published in Frontiers in Oral Health, reveals that access to specialist dental services remains extremely limited for publicly insured children across much of the country.

Researchers JonMichael Cope, Aaron David, Chase Otto and Inder Sehgal examined the availability of endodontists, oral and maxillofacial surgeons, orthodontists and dentofacial orthopaedic specialists listed through InsureKidsNow.gov. Pediatric dentists were included as a reference group because they provide both primary and comprehensive oral healthcare for children and adolescents.

Insurance Coverage Does Not Always Lead to Specialist Treatment

Medicaid and the Children's Health Insurance Program, known as CHIP, must cover essential dental services for enrolled children, including routine examinations, X-rays, fluoride treatments, sealants, fillings, relief from pain and infection, tooth restoration and medically necessary orthodontic care. Some children need procedures usually handled by specialists, including pulp treatment, complex oral surgery or correction of severe malocclusion.

Federal requirements focus largely on providing medically necessary treatment rather than guaranteeing access to a particular type of specialist. A state may technically cover a procedure even when families cannot find an endodontist, oral surgeon or orthodontic provider willing and available to deliver it.

Dental use among Medicaid-enrolled children has improved over the past two decades, rising from 29.3% in 2000 to 52.3% in 2019. Medicaid-enrolled children also use dental services at a much higher rate than uninsured children, 43.7% compared with 20.4%. Those gains have been driven partly by the expansion of publicly funded insurance, yet specialist networks have not grown evenly alongside coverage.

Low reimbursement, administrative demands, missed appointments and limited numbers of participating dentists can discourage practices from accepting Medicaid or CHIP. Families in rural communities face an added burden because fewer dentists operate nearby and even fewer accept public insurance.

Researchers Found Major Gaps Across State Dental Networks

The researchers conducted an observational, cross-sectional study using the live InsureKidsNow database between 1 and 16 December 2025. They searched every state for locations offering endodontics, oral and maxillofacial surgery, orthodontics or dentofacial orthopaedics, and pediatric dentistry, recording both total participating locations and those accepting new patients.

Endodontic locations represented only 1.30% of listings accepting new patients, compared with 6.89% for oral and maxillofacial surgery, 7.11% for orthodontics and dentofacial orthopaedics, and 12.81% for pediatric dentistry. When all participating locations were counted, including those not taking new patients, endodontics remained lowest at 1.51%, while pediatric dentistry reached 14.26%.

The differences were statistically significant, and the gaps between endodontics and each of the other categories were considered large. A sensitivity analysis excluding states affected by the website's 1,000-result limit produced the same broad pattern, supporting the conclusion that the shortage was not simply caused by the database cap.

Among the 25 states operating a single Medicaid or CHIP benefit plan, possible patient-to-specialist-location ratios ranged from 614 children per location to 154,209 children per location. These figures do not represent actual caseloads, yet they show the scale of pressure that could fall on available practices. Endodontic locations were consistently associated with the highest and least favourable ratios.

Endodontic Care Emerged as the Most Serious Weak Point

In the largest benefit plan examined in each state, 45 states had a lower percentage of endodontists accepting new Medicaid or CHIP patients than the percentage of endodontists in their overall dental workforce. Twenty states listed no endodontic location accepting new patients, while another nine reported endodontists as less than 1% of the plan's available dental locations.

The picture remained poor when researchers counted every participating endodontic location, including practices closed to new patients. Forty-four states fell below their statewide workforce benchmark, 15 listed no participating endodontic provider and another 15 had participation above zero but below 1%.

Twelve of the 25 single-plan states had no endodontic location accepting new patients, while nine had no participating endodontist at all. A website listing also cannot guarantee that an appointment is immediately available, meaning families may experience longer delays than the numbers suggest.

Access to oral and maxillofacial surgeons and orthodontic specialists was better but still unreliable. Twenty states had below-average availability of oral surgery locations accepting new patients, with 14 reporting no availability. Twenty-five states had below-average availability of orthodontic or dentofacial orthopaedic locations, including 17 with no provider accepting new patients.

Thirteen states offered no newly available location in any of the three non-primary-care specialties. Ten states showed no pediatric dentist accepting new patients, though pediatric dentistry remained far more accessible overall. Combined specialist locations accounted for an average of 5.1% of listings accepting new patients, compared with 12.8% for pediatric dentists.

The weakest specialist networks were concentrated in parts of the Pacific Northwest, lower Midwest and South-Central United States, including Washington, Oregon, Idaho, Montana, Wyoming, Missouri, Kansas, Kentucky, Mississippi, Texas and Louisiana. California was the only state whose largest plan reached the highest quartile for the combined availability of the three non-pediatric specialties.

Workforce Size, Training and Plan Participation May Shape the Shortage

Endodontists form the smallest share of the three specialist workforces studied, representing 3.49% of dentists nationally, compared with 4.46% for oral and maxillofacial surgeons and 6.41% for orthodontic specialists. Limited workforce numbers combined with low public-insurance reimbursement may leave practices with little capacity or financial incentive to participate.

Specialist training opportunities may also influence where providers eventually practise. Of the 15 states with no endodontist participating in their largest benefit plan, eight had no endodontic residency programme, and three had only one residency site. Pediatric dental residency programmes are available in more states and in greater numbers, which may partly explain the stronger pediatric provider network.

State Medicaid and CHIP dental spending did not show a strong relationship with specialist participation. Geographic proximity measures can also hide the problem because a child may live within 15 minutes of a Medicaid dentist without having similar access to the specialist required for complex treatment.

The study measured practice locations rather than individual dentists, so one dentist could appear at several addresses while several dentists could share one listed location. The InsureKidsNow search limit caused some large plans to be undercounted; smaller insurance plans may have different networks, and the research could not determine whether poor access resulted from a shortage of specialists or unwillingness among existing specialists to accept Medicaid. The analysis described provider availability without measuring the clinical demand for each service.

The findings expose a gap between having dental benefits and being able to use them. Public insurance has helped more children receive routine oral healthcare, but specialist treatment remains unavailable or severely restricted in many states, with endodontic care standing out as the most urgent weakness. Without stronger specialist networks, children needing complex treatment may face delayed care, worsening pain, preventable tooth loss and referrals that never lead to an appointment.