Boosting Oral Health Care in Rural Communities

Key Takeaways:

State Action

State lawmakers are considering legislation to address provider shortages and reduce access barriers in rural communities. These strategies include teledentistry and mobile care models, supporting the oral health workforce and insurance coverage and reimbursement policies.

Teledentistry and Mobile Dental Clinics

Teledentistry consists of a range of services, including video consultations, sharing images and patient records among providers, provider education and patient monitoring. It is a tool for connecting rural residents to oral health care, particularly in areas with limited provider availability. 

While challenges related to reimbursement, quality of care and patient safety remain, teledentistry can increase providers' capacity to screen for disease and connect patients with appropriate care. At least 46 states allow the practice of teledentistry, and most state Medicaid agencies are authorized to reimburse for teledental services. Georgia and Illinois passed legislation establishing standards for teledentistry. Some states also permit dentists to supervise dental hygienists remotely using teledentistry. For example, Utah permits dentists to supervise and collaborate with dental hygienists outside traditional clinical settings. Virginia increased the length of time dental hygienists may practice under remote supervision before a patient must be seen in person by a dentist.

Mobile dental clinics are another strategy to overcome geographic barriers to oral health care in rural areas. At least 40 state Medicaid programs reimburse for mobile dental services, but many mobile clinics use a mix of reimbursement, grant funding and donations. Connecticut addresses the long distances many rural residents travel for oral health services by allowing mobile dental clinics to submit Medicaid claims for services delivered within 30 miles of the clinics associated fixed location. Tennessee increased the number of dental hygienists a dentist can supervise when providing services through free mobile dental clinics.

Workforce Supports and Expansion

States are also addressing rural oral health access by supporting and expanding the dental health workforce. Strategies include rural-focused training programs, loan repayment incentives and scope of practice modifications.

Rural-specific training programs can help recruit providers to underserved areas. For example, the University of Washinton School of Dentistry's rural track targets students interested in rural practice and creates residency programs specific to the skills needed in rural settings.

Dentists have some of the highest levels of student loan debt among major health professionals, averaging about $300,000, which may deter providers from practicing in rural areas. All states offer loan repayment incentives for dental professionals who agree to practice in rural or underserved areas. In 2019, Maine increased the maximum loan repayment amount for eligible dentists from $20,000 to $25,000 if they agree to practice in underserved areas, most of them rural. Then, in 2023, Maine expanded the program to include dental hygienists, dental therapists, dental assistants and expanded-function dental assistants. South Dakota appropriated funds to support dentist recruitment through the rural recruitment assistance program.

States may also reduce barriers and address HPSAs by authorizing a wide variety of health professionals to provide oral health care. In 43 states, dental hygienists can practice outside a traditional dental office, either independently or under the supervision of a dentist, after meeting certain requirements. 

States may modify the scope of practice or permit additional responsibilities in these settings. Montana authorized public health dental hygienists to provide preventive services under public health supervision without the prior authorization or presence of a licensed dentist. Hawaii permits dental hygienists to perform preventive dental sealant screenings and apply preventive dental sealants under general supervision in school-based oral health programs. Montana permits dental health aide therapists to assist with primary or preventive dental care in Indian Health Service and tribal health program settings.

Integrating oral health into primary care is another strategy to improve access. Primary care practitioners can play an important role in preventive oral health care. For example, New York permits dental assistants and licensed practical nurses to apply topical fluoride varnish.

States may also explore licensure portability options to facilitate dental professional practice across state lines. Kentucky authorized the creation of academic bridge programs to reduce the time it takes for military personnel to complete licensure and credential requirements to practice, including dental specialists. Oklahoma authorized the Board of Dentistry to license a special volunteer license for a dentist or dental hygienist who is on active duty military service.

At least 12 states, including Minnesota and Arkansas, have joined the Dentist and Dental Hygienists Compact, which establishes a privilege to practice for dentists and dental hygienists in participating member states. Compacts may facilitate multistate practice, reduces administrative burdens, expands access to qualified professionals and increases employment opportunities to new markets.

Insurance Coverage and Reimbursement

Medicaid coverage can be a strategy to address accessibility to oral health care in rural areas; nearly one in four rural residents are enrolled in Medicaid. While dental benefits for children are mandatory, adult dental coverage is optional and varies by state. According to the American Dental Association's Health Policy Institute, as of 2025, nearly every state and D.C. provided some adult dental benefits and 45 states and Washington, D.C., covered dental services beyond emergency care for the general adult population.

Some states have expanded eligibility or benefits to improve access. New York and Utah authorized their states' Medicaid plans to include dental care for all residents up to 250% of the federal poverty level. Low reimbursement rates are cited as one barrier to provider participation. Some research suggests increasing reimbursement rates is one way to boost provider participation. Maryland required annual evaluations of reimbursement rates for dental services. Nebraska increased Medicaid dental payment rates by 12.5% for one year. 

Federal Action

The federal government works in collaboration with states on oral health issues in rural populations. The Health Resources and Services Administration (HRSA) supports oral health workforce development by helping states expand the workforce pipeline, attract and retain providers in underserved and rural areas, expand facilities and services, and establish teledentistry programs among other activities.

The Rural Health Transformation Program, created through the 2025 Federal Reconciliation Bill, also known as the One Big Beautiful Bill Act, provides funding to all 50 states. Several states may leverage these funds to support rural oral health initiatives.

For example, Ohio plans to expand the Ohio See Program to include both hearing and dental services for rural students. Tennessee's proposal includes extending and expanding its existing rural dental workforce pilot through 2030, with a focus on dental provider recruitment, new rural access points and preventive oral health services into Dental HPSAs. Wisconsin proposed awarding Dental Technology Grants to incentivize Medicaid participation by rural dental providers and expand mobile and telehealth access. According to CMS, at least five states included policy actions related to dental hygienist scope of practice in their state applications.