On July 4th, 2025, H.R. 1 was signed into law, with a goal to reduce federal healthcare spending. Many of the provisions of this bill will result in states and Medicaid recipients bearing more of the expense as this law rolls out over the next ten years.
Many Kentuckians already face challenges accessing routine dental care because they lack dental insurance coverage or have no dentists in their area. Delays in treatment contribute to unnecessary hospital emergency department visits, which are more expensive and resource-intensive than proper dental care.
H.R. 1 provisions will make accessing care even more challenging for many Kentuckians. Beginning January 2027, some Medicaid enrollees will be required to show evidence of at least 80 hours of work or school per month as well as more frequent eligibility redeterminations on a six-month basis. Most of the targeted adults already fulfill this requirement or qualify for exemption.
In October 2028, copays of up to $35 for Medicaid expansion adults will be a requirement for many appointments which may lead to denied services for patients who cannot pay. Although it seems small, any additional upfront cost can create a significant barrier to treatment.
As a Medicaid expansion state with a substantial rural population, Kentucky would experience the largest federal spending reduction in the nation, with an approximate $11 billion decline over the next ten years and approximately 210,000 Kentuckians are projected to become uninsured over the next decade.
The law does include a $50 billion Rural Health Transformation Fund that allows states to obtain grants for rural health programs over the next four years – a program that could allow for support in critical areas of the state.
We know investing in comprehensive dental care reduces dental and healthcare costs down the road and when Medicaid benefits are cut, emergency department visits for dental care increase. With less federal funding and more uninsured Kentuckians expected as result of H.R. 1, Kentucky policymakers must prioritize oral health in the upcoming legislative session.
