Projected Oral Health Outcomes and Costs Associated With Pediatric Medicaid Disenrollment

Importance: Medicaid provides comprehensive dental coverage to more than 37 million children in the US and plays a central role in reducing barriers to care and improving oral health outcomes. Under the 2025 One Big Beautiful Bill Act (OBBBA), many of these children may be at risk of losing their Medicaid coverage. Objective: To estimate changes in oral health outcomes and health care costs associated with projected Medicaid coverage loss among US children. Design, Setting, and Participants: A stochastic decision-analytic microsimulation model was developed to project changes in oral health and economic outcomes associated with Medicaid coverage loss among US children aged 0 to 18 years over a 10-year horizon (2025-2034). Simulated population characteristics were informed by the nationally representative National Health and Nutrition Examination Survey (NHANES) 2013-2018. Sensitivity analyses evaluated uncertainty in policy magnitude and structural assumptions. All analyses were performed from July 25 to March 2, 2025. Exposure: Projected annual Medicaid disenrollment of 480 000 children under the 2025 OBBBA from 2025 through 2034. Main Outcomes and Measures: Incremental incident caries events and emergency department visits for nontraumatic dental-related conditions, quality-adjusted life-years (QALYs), and health care costs. Results: The simulated cohort was based on 11 696 NHANES participants aged younger than 19 years (mean [SD] age, 9.2 [0.1] years; 5778 [weighted percentage, 49.2%] females). Over 10 years, projected coverage loss was associated with 95 799 (95% uncertainty interval [UI], 15 107-171 514) additional incident caries events, 27 084 (95% UI, -41 015 to -12 458) QALYs lost, and $86.5 million (95% UI, $47.1-$125.1 million) in additional health care costs in the base-case scenario. Across alternative policy impact scenarios, incremental caries events ranged from 54 051 (95% UI, -5354 to 111 084) to 161 231 (95% UI, 58 630-261 271), and incremental costs ranged from $47.9 million (95% UI, $17.1-$77.6 million) to $145.8 million (95% UI, $92.5-$193.4 million). Conclusions and Relevance: In this decision-analytic microsimulation modeling study, projected pediatric Medicaid coverage loss was associated with worsening oral health outcomes and increased health care costs. The magnitude of impact varied with the scale of coverage loss but remained adverse across alternative policy scenarios.