For years, dentists have been unfairly criticized for the lack of access to dental care in rural Pennsylvania.
The common narrative goes: if only more dentists participated in Medicaid( also known as Medical Assistance, or MA), patients would be better served. But this misses the mark entirely. The real barriers are built into the structure of Pennsylvania’ s Medicaid program itself.
We have seen this movie before. Over the last three decades, dental schools opened new programs or expanded class sizes under the promise of addressing access to care. Yet, new graduates burdened with crushing educational debt and other lucrative opportunities have understandably chosen to work in metropolitan areas, not rural areas. Others have argued for mid-level providers— expanded function hygienists or dental therapists— but these models remain largely unevaluated and ill-suited to meet the complex needs of adults with complex dental and medical conditions, and particularly under the current funding system of MA.
The true culprit is the Medicaid system. For adults, reimbursement rates are not only low— they fall below the cost of operating a dental practice. Worse, the system is tangled in bureaucracy: credentialing, benefit-limit exceptions, and preauthorization requirements that often lead to denials weeks or months after patients first sought care. It is not surprising then that only 23 % of Pennsylvania adults on Medicaid used dental services in 2021, compared with 60 % of commercially insured adults.
Contrast that with children’ s Medicaid. When Pennsylvania removed some of these bureaucratic barriers and paid somewhat better fees, access improved. In 2021, 51 % of children covered by Medicaid saw a dentist, compared with 73 % of their peers with commercial insurance.
Rural communities suffer the most. In counties hit hard by the loss of mining and manufacturing, as many as one in five residents are covered by Medicaid. Poverty rates are higher than in urban areas, yet adult dental benefits remain the most limited. No wonder rural Pennsylvanians have the lowest access to dental care in the state.
The problem is not only a lack of dentists. It is a Medicaid program administered through layers of managed care organizations and third-party contractors, draining resources through bureaucracy instead of delivering care. This structure discourages dentists from participating, pushes away Dental Service Organizations from investing in rural dental care and leaves rural families stranded.
At Temple University’ s Kornberg School of Dentistry, we believe in a different approach. In 2026, we will open a 23-chair comprehensive dental clinic in Tamaqua to provide dental care exclusively for Medicaid eligible patients and low-income Pennsylvanian( less than 200 % of the poverty line) who are not covered by any commercial insurance. The new clinic will be serving multiple counties with comprehensive dental care and will be equipped with advanced radiography and digital scanners and milling units. Twenty dental students will live in the community for two years in free, fully-furnished apartments, gaining experiences in treating underserved patients. The clinic will operate evenings and weekends, partner with St. Luke’ s Rural Family Clinic, run a schoolbased prevention program and collaborate with Lehigh Carbon County Community College to expand the pipeline of dental assistants and hygienists.
Like all Temple University dental programs, the Tamaqua dental clinic is an educational and comprehensive dental career center working hand in hand. It is a model that acknowledges rural Pennsylvania’ s reality rather than papering over it with ineffective fixes. It will create jobs in a rural area. And, hopefully it will engender comfort for dental graduates to live in one of the most beautiful areas in the United States.
Like Temple University’ s founding story of“ acres of diamonds,” we believe diamonds can still be found in rural Pennsylvania— if we look with the right lens. It’ s time to stop blaming dentists, dismantle the bureaucratic barriers, transfer the savings to Pennsylvanians, and invest in community-focused solutions in collaboration with dental providers, primary care providers, local health care systems, community leaders, and policy makers.
SEPTEMBER / OCTOBER 2025 | PENNSYLVANIA DENTAL JOURNAL 21