July 1 Changes to State Funded Dental Programs

Becky O'GuinFeatured News, Government Relations & Advocacy

Despite the dire state of the 2026 Colorado government budget, where the Joint Budget Committee(JBC) of the legislature was forced to cut upwards of $1.5 billion in state spending, the

CDA was able to advocate for access to oral healthcare and has prevented more severe targeted cuts that could have jeopardized the viability of state-funded dental programs. 

Recap of Past State Budget Struggles

In 2025, the state legislature dealt with a $1.2 billion shortfall for state government program funding and, as noted in the article, in 2026, the budget deficit worsened. The state’s constitutional requirements of a balanced budget and of restrictions on growth of government (known as the Taxpayer Bill of Rights, or TABOR) coupled with fiscal changes at the federal level in July 2025 led to the worsening state budget situation. Public programs across state government, including the Medicaid program, had to be cut for the state to have a balanced budget.

As you likely know from the CDA’s eNews articles, in 2024, the CDA and its Medicaid committee were able to gain significant increases for 25 preventive and select treatment codes, especially for endodontic treatment. Unfortunately, in October of 2025, the Medicaid dental program was targeted for cuts by the Governor. At the time, Medicaid dental rates for these recently increased codes were cut by approximately 15% (only the 25 codes were impacted). It is notable that these rates remain well above where they had been in 2023, prior to when the CDA had advocated for and secured significant increases to these targeted rates.

The JBC had to make difficult decisions that affected state funding for programs across ALL facets of state government.

For dental care, this resulted in the reinstatement of a Medicaid adult dental benefit cap at $3,000 annually (which is higher than the previous cap of $1,500 that had been in place until 2023). The JBC also approved an across the board cut of 2% to ALL Medicaid rates (not just dental). Additional details are provided below regarding impacts to Medicaid dental and other dental care programs:

Starting July 1, 2026, the following state budget changes will take effect:

  • Medicaid (Health First Colorado):
    • Adult dental benefits will be capped at $3,000 annually
      • The annual limit starts every year on the state fiscal year (July 1) and ends on June 30.
      • This is a cap only on adult benefits; children covered by Medicaid will not have any dental benefit cap.
      • Emergency dental care and dentures are exempt from this cap.
      • If an adult hits their $3,000 maximum in a year, any further services the patient receives would be considered non-covered services. A dentist would be permitted to charge the patient for care if the patient were seeking further care. Prior to providing non-covered services, the patient and dentist must sign the state’s Non-Covered Service Disclosure Form. Dentists are encouraged to bill members at or near the current Medicaid fee schedule amount, though that is not required.
    • All Medicaid rates will be cut by 2% 
      • This 2% rate cut impacts all rates for Medicaid healthcare services, including all dental rates.
      • DentaQuest will be updating their fee schedule online once this cut is effective on July 1, 2026 – the fee schedule can be found here: https://www.dentaquest.com/en/providers/colorado
  • Cover All Coloradans (CAC) Program:
    • CAC is  Colorado’s look-alike Medicaid program for children and pregnant women or women up to one year post-partum who do not have legal status in the U.S.
    • Dental benefits will be capped at $1,100 annually
      • This applies to children as well as pregnant/post-partum women who receive their health benefit coverage through CAC.
      • For this program, dentures and emergency treatment are included within the dental benefit cap and count toward the CAC member’s annual capped benefit amount.
      • Of note: Currently, children and pregnant/post-partum women who get health insurance through CAC have the same Medicaid card as standard Medicaid members. Because this population will have a different dental benefit cap than Medicaid adults, the state may be implementing a way to differentiate those receiving services through CAC versus those receiving services through Medicaid, however we do not yet have details on if that will happen or what it will entail.
  • Senior Low-Income Dental Program
    • The Colorado Dental Health Care Program for Low-Income Seniors provides access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental healthcare program, such as Health First Colorado (Colorado’s Medicaid Program).
    • Funding for the program will be cut in half, from approximately $4 million to approximately $2 million
      • The program operates primarily by providing grants to entities that apply to provide dental care to the eligible population. It can be expected that starting in the next fiscal year (beginning July 1), there will be fewer grantees who get awarded, lower grant amounts to grantees, or potentially a combination of those funding changes.

While the budget deficits have resulted in cuts in reimbursement rates, the CDA has continued to focus on keeping the cuts to a minimum. The CDA continually shares with the Department of Health Care Policy and Financing (HCPF) and the state legislature that the only way to improve access to necessary dental care for over 25% of the residents of Colorado is to ensure that reimbursement rates remain at a level where providers can provide care for Coloradans with Medicaid.