BY LESLIE ABASTA AND JEFFREY LEWIS

Special to the Journal

When Congress passed the largest Medicaid cuts in U.S. history last year, the consequences for California were often described in sweeping numbers: billions of dollars lost, millions at risk of losing coverage. What has received far less attention is how those federal cuts are already reshaping something more mundane — but just as essential — as dental care.

For the millions of Californians who rely on Medi‑Cal, the state’s Medicaid program, dental care is once again becoming a casualty of budget pressure. And history suggests that once dental access erodes, health outcomes — and long‑term costs — quickly follow.

California learned this lesson the hard way. During the Great Recession, the state eliminated most adult Medi‑Cal dental benefits as a cost‑saving measure. For years, low‑income adults could receive little more than emergency extractions and pain control. Preventive care disappeared. Dentists left the program. Emergency rooms are filled with patients seeking relief from untreated infections.

It took nearly a decade to undo that damage. In 2018, California fully restored comprehensive dental benefits for adults and began rebuilding the dental safety net. Voter‑approved funding increased reimbursement rates, more dentists enrolled in Medi‑Cal, and hundreds of thousands of patients finally established regular dental care. It was slow, costly work — but it worked.

Today, that progress is in jeopardy.

The federal Medicaid reductions enacted in 2025 have created a massive budget shortfall for California’s Medi‑Cal program. While dental care is not singled out in federal law, it is among the most vulnerable services when funding shrinks. Under federal rules, adult dental benefits are considered “optional,” making them politically easier to cut when states are forced to triage.

That vulnerability is now becoming reality.

Beginning in mid-2026, California eliminated comprehensive Medi-Cal dental benefits for undocumented adults covered by state funds. These patients will be limited to emergency dental care only — extractions, pain relief, and little else. Preventive cleanings, fillings, crowns, dentures, and root canals will no longer be covered.

State officials estimate the move will save a few hundred million dollars a year. But the savings from restricting dental care are often illusory. When preventive dental services vanish, people don’t suddenly stop needing care. Instead, they delay treatment until pain becomes unbearable, infections worsen, or teeth are lost entirely. Costs shift from dental offices to emergency rooms — a far more expensive and less effective setting for treating oral disease.

Federal cuts are also destabilizing the provider side of the equation. Dental care under Medi‑Cal has always struggled with low reimbursement rates. California historically ranks near the bottom nationwide in what Medicaid pays dentists. In recent years, supplemental funding allowed the state to begin closing that gap.

New federal restrictions now limit California’s ability to raise and distribute Medi‑Cal funds through mechanisms voters previously approved. As a result, future increases in dental reimbursement — and even the preservation of existing rates — are uncertain.

Dentists are paying attention. Surveys suggest that nearly half of dentists who currently accept Medi‑Cal would consider leaving the program if funding deteriorates further. Others plan to limit the number of Medi‑Cal patients they see. In practice, this means that even Californians who technically remain “covered” may be unable to find a dentist willing to see them.

Rural communities and the Central Valley are likely to feel the pain first. These regions already face dentist shortages and higher Medi‑Cal enrollment. Community health centers — which provide millions of dental visits to Medi‑Cal patients each year — are also bracing for reduced reimbursement and growing uncompensated care. Fewer resources mean shorter hours, longer waits, and fewer dental chairs operating.

The human cost of these shifts is easy to overlook until it becomes personal: a worker who can’t afford dentures and avoids job interviews; a child who struggles in school because of untreated tooth pain; a senior subsisting on soft foods because oral infections make eating difficult.

Oral health is not cosmetic. It is closely linked to diabetes, heart disease, pregnancy outcomes, and mental health. When dental care disappears, overall health suffers — and inequality widens.

California prides itself on being a national leader in health policy, but leadership depends on stability as much as ambition. Dental care cannot be the program that expands during good times and collapses during downturns. That cycle is costly, inefficient, and deeply unfair to patients who depend on continuity of care.

Federal Medicaid cuts have placed California in an unenviable position. But how the state responds matters. Policymakers can continue to treat dental care as expendable — or they can recognize it as a cornerstone of preventive health that saves money over time.

The quiet erosion of Medi‑Cal dental care may not make headlines like hospital closures or coverage losses. But its effects will be felt just as sharply — in emergency rooms, classrooms, workplaces, and homes across California.

The question now is whether we intervene early or, once again, wait until the damage is unmistakable — and far more expensive to repair.

— Leslie Abasta is the CEO of Lumira Healthcare and Jeffrey Lewis is the CEO of Legacy Health Endowment. The words expressed are their own.