Expanding Medicare to Include Dental: A Path to Better Oral Health in Nursing Facilities
October 7, 2025
by Samantha Morales
Introduction
This issue brief is the third in a series of papers that examine how to address barriers in access to care and oral health outcomes among certain groups of Medicare enrollees, including people of color, people with disabilities, and older adults with dementia and cognitive impairments. These briefs build on the issue brief, Creating an Oral Health Benefit in Medicare: A Statutory Analysis, where Justice in Aging provided an analysis of the statutory changes that would be needed to add an oral health benefit to Medicare Part B.
Medicare’s Coverage of Dental
In law, Original Medicare explicitly excludes coverage of most dental services.[1] Since 2022, CMS began issuing regulatory changes that have clarified when Medicare payment can be made for dental services that are inextricably linked to and substantially related to the clinical success of a specific treatment of an individual’s primary medical condition. For example, Medicare will now pay for dental examinations and needed dental services to treat a Medicare-covered organ transplant, head and neck cancer, cancer prior to or during chemotherapy, cardiac valve replacement, or valvuloplasty procedure. These dental services can be rendered in an inpatient setting covered under Medicare Part A and an outpatient setting paid under Part B.[2] Most recently, CMS clarified that Medicare payment can be made for dental services that are inextricably linked to Medicare covered dialysis services for the treatment of end-stage renal disease.[3] Medicare Advantage plans, including Dual Eligible Special Needs Plans (D-SNPs), are required to provide all Medicare covered benefits, including inextricably linked medically necessary dental services. [4] CMS accepts nominations for additional clarification of this policy on an annual basis through the Medicare Physician Fee Schedule.[5]
HRSA’s Oral Health Initiative—A Healthy Mouth for Every Body—Now Includes Information on Pregnancy and Nutrition
A Healthy Mouth for Every Body, led by HRSA’s Office of Special Health Initiatives, raises awareness about the connection between oral health and overall health. The website addresses oral health care for babies and young children. Learn more about oral health and pregnancy and oral health and nutrition.
Wyoming Medicaid Increases Dental Codes
Attention Dental Providers
Effective April 1, 2023, Wyoming Medicaid implemented a legislation approved 25-percent increase for all dental codes. Wyoming Medicaid has recognized the increasing costs of providing care for members of Wyoming and the ongoing issues related to care access for dental services. We are confident the increase will benefit both the providers and members of Wyoming. Providers are urged to utilize the updated 2023 Dental Fee Schedule located on the Dental General Manual, Covered Services and Bulletins web page of the Wyoming Medicaid website.
Providers interested in enrolling to be a Wyoming Medicaid provider can visit https://wyoming.dyp.cloud/ to begin the enrollment process.
For more information on the rate increase, please contact Provider Services at 1-888-996-6223.
For questions on enrollment, please contact the HHS Technology Group at 1-877-399-0121
This website is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of awards to the State Office of Rural Health, the Wyomlng Primary Care Office (PCO), the Medicare Flexibility (Flex) Program and the Small Rural Hospital Improvement Program (SHIP). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.