Rural Kids on Medicaid Get More Fillings and Fewer Cleanings, New 2026 Study Finds

Updated July 2026

A June 2026 policy brief from the University of South Carolina Rural Health Research Center finds that rural children ages 2 to 5 on Medicaid needed fillings and crowns at higher rates than children in metro areas, even as both groups largely missed the two dental cleanings a year that pediatric dentists recommend. The gap in tooth decay diagnoses between rural and metro children also widened between 2021 and 2022, a sign that the rural dental access gap is not closing on its own.

Key facts

• Rural children on Medicaid needed a filling or crown at a rate of 19.49 percent in 2022, compared with 16.64 percent for metro children. Source: University of South Carolina Rural Health Research Center, June 2026.
• Close to 8 in 10 Medicaid enrolled children ages 2 to 5 (78.76 to 79.63 percent) did not get the recommended two dental cleanings in 2022. Source: University of South Carolina Rural Health Research Center, June 2026.
• Only 5.6 percent of the nation's dentists practice in rural areas, and 67 percent of the country's 7,306 dental Health Professional Shortage Areas are rural. Source: HRSA data cited in the University of South Carolina Rural Health Research Center's June 2026 brief.

What did the new study actually find?

The brief found that rural Medicaid enrolled children ages 2 to 5 were more likely than their metro peers to need restorative dental work, while cleaning rates stayed low almost everywhere. Researchers Cassie Odahowski, PhD, MPH, Elizabeth Crouch, PhD, Peiyin Hung, PhD, MSPH, and colleagues at the University of South Carolina's Arnold School of Public Health analyzed Medicaid claims for 9,125,333 children nationwide from January 2021 to December 2022, using the Centers for Medicare and Medicaid Services' Chronic Conditions Data Warehouse. They sorted children by rural, small town, and metropolitan home addresses to compare how much preventive, restorative, and diagnostic dental care each group actually received.

Source: University of South Carolina Rural Health Research Center, "Rural vs. Urban Patterns of Dental Care Services and Outcomes Among Medicaid-Enrolled Children in Early Childhood," June 2026. Among the rural children diagnosed with decay, 35 to 36 percent had three or more cavities, the brief found.

Why are rural kids getting more fillings but not more cleanings?

Many rural children appear to be reaching a dentist's chair only once a cavity already needs treatment, rather than for the twice yearly preventive visits pediatric dentists recommend. The brief ties this to a thin rural dental workforce: nationally, only 5.6 percent of dentists practice in rural areas, and roughly half of rural dentists accept Medicaid patients at all, according to the HRSA figures cited in the brief. Medicaid dental reimbursement also runs well below private insurance rates, which the brief notes discourages some practices in thin rural markets from taking on more Medicaid patients, even when families are covered on paper.

How does this connect to the broader rural dentist shortage?

It connects directly, since the study's restorative care gap shows up in the same places the government already flags as underserved. The brief cites 7,306 dental Health Professional Shortage Areas nationwide as of 2023, with 67 percent of them rural. Smile Listing has covered how thin that safety net can get in practice: Shawnee Health's new Children's Dental Center in Marion, Illinois, set to open September 1, 2026, is described as the only Medicaid accepting pediatric dental facility in all of Southern Illinois, with close to 200 children already on a waiting list before its doors open.

Does the access gap show up outside Medicaid too?

Yes, related 2026 research suggests the same access gap pushes some rural residents toward emergency rooms instead of routine dental care. A separate study led by Texas A&M University College of Dentistry, sponsored by Delta Dental and published in the Journal of Public Health Dentistry, examined rural emergency department visits for dental pain across eight states. Lead researcher Marvellous Akinlotan, BDS, PhD, a clinical assistant professor in pediatric dentistry at Texas A&M, put it directly: "Coverage without access, or without dental benefits, does not translate into care. For rural communities, Medicaid dental benefits must be both comprehensive and functional."

What can rural families do to find a dentist who accepts Medicaid?

Start with your state Medicaid agency's list of participating dental providers, since acceptance varies widely by practice even within the same county. Community health centers and school based sealant programs are also worth checking, as many take walk ins for basic preventive care. Local directories can help too: families in rural areas can search for a nearby children's dentist, such as Wilderness Station Pediatric Dentistry in Lincoln, Nebraska, to confirm Medicaid participation and book a first preventive visit before a small cavity turns into a filling.

Frequently asked questions

What age group does the study cover?

Children ages 2 to 5 enrolled in Medicaid, using national claims data from January 2021 to December 2022.

Who published the research?

The University of South Carolina Rural Health Research Center published the policy brief in June 2026, based on CMS Medicaid claims data.

Are rural children more likely to have Medicaid coverage than urban children?

Yes. About 47 percent of rural children are covered by Medicaid, compared with 40 percent of urban children, according to the brief.

Does the study explain why cleaning rates are low everywhere?

The brief does not point to a single cause, but notes low cleaning rates persist across rural, small town, and urban areas alike, which suggests broader barriers such as appointment access rather than geography alone.

Sources: University of South Carolina Rural Health Research Center, Rural Health Research Gateway; full policy brief, June 2026; Delta Dental press release on rural emergency dental visits.

Updated July 2026.