Policy Solutions to Dental Health Financial Disparities in California

Donna Jalai, Aimee Park, Trinity Low

Project Smile Global

20 September, 2025

Illustration of a dentist holding an extracted tooth

The sunny state of California is home to over 39 million Americans and is the most populous state in the United States (“California’s Population”). Given the large number of residents in California, there are numerous policies and studies surrounding how to best provide dental health services. However, with the large income divide in California, as well as the continuously increasing cost of living, financial disparities within dental health care continue to rise. High dental insurance rates, lack of dentists participating in more affordable dental coverage plans, and a lack of education surrounding dental insurance and the costs of dental treatment, are important factors to consider when creating public policy to address dental care (Pourat et al. 1). This article examines policy solutions to address these dental health financial disparity concerns, including the advantages and disadvantages of current policies. Suggestions for potential solutions to these pressing issues, based on current data and studies done within the state, are also outlined. 

The primary priority to mitigate dental health financial disparities is to increase access to affordable dental care, using the policies currently set in place by the state of California. The state’s affordable health insurance plan, Medi-Cal, also has a branch that provides access to dental care, named Denti-Cal (Pourat et al. 1). This plan provides eligible citizens of California access to affordable dental care, often covering the entire cost of cleanings, fillings, and other preventative and basic restorative services (Pourat et al. 1). The main issue regarding Denti-Cal is that it provides relatively low reimbursement rates for the dentists, essentially meaning they are being paid very little for their work (Taylor 1). As such, there is low participation in Denti-Cal, with roughly 20% of dentists participating in the program since 2018 (Taylor 1). To compare, about 15.6 million Californians rely on Denti-Cal for their dental care, representing about one-third of the population (Pourat et al. 5). As such, there is a high demand for Denti-Cal-covered dental care, but a low supply of dentists participating in the program, creating financial disparities and prolonged dental treatment for millions throughout the state (Pourat et al. 5). One way to combat this issue is to incentivize more dental providers to register with Denti-Cal. To do so, negotiations of fairer compensation for dental providers offering services through Dent-Cal must take place. This would aim to increase dentists’ funds and, in turn, increase dental services for patients throughout the state (Pourat et al. 6). 

One of the most pressing issues in California’s dental policy was the state’s decision to cut funding towards adult oral care. Following the nation’s economic recession in 2009, California eliminated all adult Denti-Cal coverage for non-emergency procedures, with the exception of pregnant women and residents of skilled nursing care facilities (Wides 5). Patients were no longer able to afford basic treatment plans, much less restorative care. Denti-Cal-eligible adults reported longer wait times and primarily sought emergency dental care, presenting with more extensive diseases (Wides 5). As providing offices were forced to decrease their services, all dental schools that were interviewed reported a greater influx of Denti-Care patients, which consequently added additional financial stresses due to significant cuts in educational funding from the state (Wides 8). The budget cut also forced dental schools to “increase the provision of urgent care and train their pre-doctoral students in simple extractions, which previously were performed in oral surgery.” (Wides 8). Further, both urban and rural parts of the state with large underserved communities experienced an increase in Denti-Cal beneficiaries needing care, coinciding with a decrease in available funding to provide such care (Wides 6). Between 2008 and 2010, the state’s 58 counties experienced an increase in unemployment rates from below 10% to rates between 15% and 28% (Wides 6). This pushback led patients to skip routine checkups and cleanings for preventative care (Wides 6). Such gaps not only worsened oral health outcomes but also systematically increased the cost of dental care, since preventative care is often less expensive than emergency treatment.  

In contrast, New York’s Medicaid system creates a more streamlined approach to oral care than California’s stand-alone Denti-Cal program. Since 2024, New York has expanded its coverage to include wider coverage for root canals, crowns, replacement dentures, and dental implants (New York State Department of Health 1). These increased precautionary measures ensure that vulnerable populations are not left with unaffordable dental bills. California could adopt similar policies by incorporating dental care into broader managed care systems and mandating coverage for essential, medically related oral treatments. Together, these steps could strengthen access, reduce financial disparities, and create a more stable and equitable dental care system. 

Future Directions for California

Identifying the root of the issue and comparing California’s current system to other successful models is the first step in a series of necessary actions. To address some of California’s most pressing oral health care issues, it is essential to strengthen the dental workforce, expand preventative measures, and implement more efficient and cost-effective care. 

First, as mentioned earlier, there is a shortage of dentists participating in the Denti-Cal program. In fact, as of 2021, 71% of California’s dentists were not actively treating Medicaid patients (Dizon et al. 5) This resulted in a small number of dentists, who were more likely older and near retirement age, with a large patient population of low-income adults (Dizon et al. 5). Therefore, according to the Center of Oral Health, it is not only crucial to increase reimbursement rates, but to also simplify administration procedures to make it easier for more dentists to participate in the Medicaid dental program (Dizon et al. 4)

In addition to this, dentists also remained low in racial and ethnic diversity nationwide with only 6% of practicing dentists who were Hispanic and 2% Black (Dizon et al. 4) This contrasts significantly with the state’s diverse patient profile, in which53% identify as Hispanic and 7% as Black (Dizon et al. 4). The low racial and ethnic diversity among dentists can also be attributed to the decreased financial assistance for dental schools since the 1980s and the yearly tuition rate increase (Dizon et al. 4) The significant financial costs of dental education are a barrier to some pre-dental students, especially from underrepresented populations. To ease the financial barriers and address the shortage of oral healthcare providers in underrepresented areas, federal and state programs have offered students loan repayment programs and scholarships to assist with some of these costs. However, in order to continue to address the shortage of providers in underserved communities, it is important for more students to be informed and have early knowledge about these programs (Dizon et al. 5). Studies have also shown that students from underserved communities are more likely to serve underrepresented communities, which would address both provider shortages and diversify the ethnic and racial provider population (Dizon et al. 5).

Second, to improve oral health among all populations, it is essential to enhance preventive measures. One way to do this might be to improve access to care through school oral health assessments. California currently has the kindergarten oral health assessment (KOHA) in place (Saraza et al. 1). To address the high prevalence of dental diseases among children, this screening has been implemented to both improve access to care and encourage children and their families to adopt oral healthcare practices. The screening is provided to public school kindergartners. Following a brief oral inspection, their health status and treatments are presented to their caregivers for appropriate follow-up treatment (Saraza et al. 1). While KOHA is an excellent step in the right direction, factors such as the shortage of dental providers hinder its original objectives. KOHA’s primary purpose was to link underserved children to dental homes. However, there are several concerns about referring patients to providers, struggles to schedule appointments, and prolonged wait times, which all decrease patient satisfaction and ultimately patient trust (Saraza et al. 3). Therefore, other integrative methods should be explored to increase patient trust and increase efficiency.

A key strategy to increase efficiency is by implementing more preventative measures. KOHA should not be the only safety measure.  More screenings should be coordinated in collaboration with dental schools, where oral hygiene kits are provided to those without basic oral hygiene supplies.  This would also provide an opportunity to emphasize the importance of oral hygiene, and tobe taught the basics of proper oral hygiene habits (Saraza et al. 4). Another approach would be to expand the use of Telehealth to provide services to a broader population. Telehealth services were most widely used during the Covid-19 pandemic. During this time, oral health instructors partnered with public schools to coordinate virtual oral hygiene instruction sessions, counseling, and overall dental health  (Saraza et al. 5). As such, expanding Telehealth opportunities across the state could create an initial framework from which more communities, schools, and populations are targeted. 

It is evident that a multitude of policies must be adopted to help the citizens of California receive adequate dental care in light of the financial concerns. It is important to build upon the resources already available to the citizens, such as Denti-Cal. However, the state of California should prioritize allocating further funding to adult oral health. Further, Denti-Cal needs to fairly compensate dental care professionals, to ensure a sufficient number of professionals provide services in accordance with both Medi-Cal and Denti-Cal, thereby providing services to the millions of citizens that rely on these plans  (Pourat et al. 5-6). California can look for inspiration from other states, such as New York, to create more successful and accessible dental care programs (New York State Department of Health 1). Furthermore, it is important that the dental field expands to represent the patients it aims to treat; a lack of black and Hispanic dentists contrasts with the large population of both populations, particularly Hispanics, in the state. A lack of representation and understanding between healthcare providers and patients can create further disparities for these minority groups, and it is important that the state advocates for more Hispanic and Black students to pursue dentistry as a field of study. To facilitate this change, dental school costs need to be reduced, as many Hispanic and Black students from low-income families may be unable to take on the large loans required to pursue a dental education  (Dizon et al. 4-5). Lastly, incorporating more preventative measures for oral health issues would mitigate the need for expensive dental treatments, thereby overcoming the financial barriers for many Californians.

Works Cited

“California’s Population Increases - Again.” Governor Gavin Newsom, 1 May 2025, www.gov.ca.gov/2025/05/01/californias-population-increases-again/. 

Dizon, Marie Beverly, et al. “Opportunities to address healthy people 2030 dental care access challenges in California.” Journal of the California Dental Association, vol. 53, no. 1, 8 Apr. 2025, pp. 1–9, https://doi.org/10.1080/19424396.2025.2483732. 

New York State Department of Health. “Clinical Criteria Revisions to the New York State Medicaid Program Dental Policy and Procedure Code Manual.”eMedNY,17 November 2023, https://www.health.ny.gov/he alth_care/medicaid/program/dental/docs/dental_clinical_criteria_guidance.pdf. Accessed 2 September 2025.

Pourat, Nadereh, et al. “The Challenge of Meeting the Dental Care Needs of Low-Income California Adults With the Current Dental Workforce.” UCLA Center for Health Policy Research, 2021, pp. 1-8. JSTOR, http://www.jstor.org/stable/resrep43290. Accessed 30 August 2025.

Saraza, Paulina A., et al. “Improving access to care through school oral health assessments.” Journal of the California Dental Association, vol. 51, no. 1, Mar. 2023, pp. 1–7, https://doi.org/10.1080/19424396.2023.2173880. 

Taylor, Mac. “Improving Access to Dental Services for Individuals With Developmental Disabilities.” Legislative Analyst’s Office, Sept. 2018, pp. 1-40, https://lao.ca.gov/Publications/Report/3884  Illustration of a dentist holding an extracted tooth. The DeHayes Group, https://b2059642.smushcdn.com/2059642/wp-content/uploads/2021/12/member benefits-dental-insurance-tips.jpg?lossy=1&strip=1&webp=1 lossy=1&strip=1&webp=1. Accessed 31 August 2025.

Wides, Cynthia, et al. “Shaking Up the Dental Safety-net: Elimination of Optional Adult Dental Medicaid Benefits in California.” PubMed Central, Feb 2014, pp 1-15, https://pmc.ncbi.nlm.nih.gov/articles/PMC4175711/#S6.