Furaha Moyé owes her smile to Harlem United.
The community health center, based in Upper Manhattan, has served as a steady source of affordable, quality dental care for the 76-year-old Harlem resident for more than a decade. Faced with challenging dental issues since she was a child, Moyé said the services she receives at the center are essential to her career as an actor and model.
“I know that I would have really gone [into myself] had I not gotten that care because the self-esteem, the confidence, the whole nine is impacted,” she said.
Frustrated by how expensive dental care is, Moyé is equally grateful to Harlem United for its commitment to serving patients regardless of their ability to pay. Too often, the financial stresses that come with accessing dental services can stand in the way of overall good health, she said.
“If your teeth are not good, the rest of your body can’t be good either,” she said.
Community health centers like Harlem United serve as the few sources of dental care for low-income populations in New York City. Now, however, policy changes to Medicaid under the Trump administration’s “One Big Beautiful Bill” legislation increasingly threaten the ability of these safety-net providers to care for patients in underserved communities.
“It’s a huge cliff that’s coming for community health centers,” said Melissa Burroughs, senior director of policy and advocacy at the CareQuest Institute for Oral Health. “The reality we’re going to see is a lot more people … not getting care at all.”
The high costs of dental care
Research shows that regardless of insurance status, more people cite cost as a barrier to accessing dental care as compared to any other type of health care. The financial burdens associated with seeking dental care have a disproportionate impact on low-income populations. Families living below the federal poverty line spent 2% of their total family income on dental care in 2021 compared to high-income families who only spent 0.3%, according to a CareQuest Institute for Oral Health report.
For many, Medicaid, which provides health insurance for low-income individuals and people with disabilities, can serve as a lifeline for accessing affordable dental care. Jointly funded by the federal government and state governments, Medicaid provides comprehensive dental care to children under the age of 21; coverage for adults varies by state. Only 11 states (not including New York) and Washington, D.C., provide extensive dental coverage for adults, according to data published by the CareQuest Institute.
Barriers to Medicaid acceptance
Finding a dental provider who accepts Medicaid can be a challenge. In New York State, the program reimburses participating dentists at about a third or less of average dental charges, according to 2024 data released by the American Dental Association. Only one-third of New York dentists accept Medicaid, according to a report by the Center for Health Workforce Studies at The State University of New York at Albany.
“It’s a losing proposition,” said Dr. Maurice Edwards, president of the New York State Dental Association, whose organization has been at the forefront of advocating for higher reimbursement rates.
Dental providers also cite frequent missed appointments among Medicaid patients as contributing to their lack of participation in the insurance program, research shows.
In light of the many documented socio-economic challenges faced by low-income populations, including transportation barriers and inflexible work schedules, such biases against Medicaid participant populations frustrate dental care advocates.
There is “a longer-term cultural shift that has to happen in terms of how … society and how providers view certain populations of patients,” said Colin Reusch, director of policy at Community Catalyst.
Lack of affordable dental care for NYC communities of color
In New York City, the shortage of dental providers who accept Medicaid is evident. Across the city, many neighborhoods lack enough dental providers to meet the needs of populations eligible for Medicaid, according to the federal government. The determination, by the Health Resources & Services Administration, accounts for each area’s percentage of population below the federal poverty line, as well as its proximity to the nearest dental provider.
The majority of shortage provider areas are located in the city’s predominantly low-income communities of color.
The Bronx, whose population is more than 50% Latino and more than a quarter Black, accounts for a significant portion of the city’s dental provider shortage areas. Communities in neighborhoods such as High Bridge and Hunts Point are among the poorest in New York City, with more than a quarter of the population living in poverty. Nearly 65% of the borough’s residents are enrolled in Medicaid, according to 2024 data analyzed by the United Hospital Fund.
Other provider shortage areas in the city include Central Harlem, where Blacks comprise half the population and Latinos nearly a quarter. Approximately 29% of that population lives in poverty, compared to the citywide average of 18%, based on data from the Furman Center for Real Estate and Urban Policy at New York University.
Overall in New York State, about 35% of Medicaid beneficiaries are white, 18% are Black, and 31% are Latino, according to figures from KFF.
Importance of oral health
A lack of access to affordable dental care has contributed to deepening oral health disparities among populations of color. Black and Latino adults experience untreated tooth decay at nearly twice the rate of their white counterparts, according to data from the Centers for Disease Control. Black adults are also more likely to report tooth loss due to tooth decay or gum disease compared to white adults. Poor oral health may also affect the financial stability of populations of color: Blacks and Latinos are at least twice as likely to point to the quality of their teeth or use of dentures as a reason for unemployment, research shows.
Among children, Blacks and Latinos also experience twice the rate of untreated tooth decay compared to white children, with the condition prevalent in more than half of Latino youth between the ages of 2 and 19. Children with a history of dental issues are more likely to have school absences, poor grades, and low self-esteem, according to research published by the American Journal of Public Health.
Poor oral health can also be a sign of underlying disease in the body, said Dr. Jerica Cook, president of the Bronx County Dental Society.
“A lot of [what] you see … in the dental chair [is] a reflection of everything,” she said, noting the many times she has diagnosed chronic illnesses through a patient’s oral exam. “There are a lot of presentations in your mouth that correlate to other things.”
Commonly known as the “oral-systemic connection,” the physiological relationship between the mouth and the rest of the body can have a significant impact on a person’s health. Dozens of conditions, including cardiovascular disease, diabetes, and neurodegenerative conditions like Alzheimer’s disease, exhibit oral manifestations such as plaque build-up and gum inflammation, research shows.
Reflecting on the role of a dentist on a patient’s overall health, Cook worries about those who face barriers in accessing quality dental care. A dentist can provide another safeguard for an individual’s health, she said, leaving people who are unable to receive dental care. “You’re missing extra eyes on you,” she said.
The role of community health centers
Located just blocks away from Central Harlem’s famed Apollo Theater, Harlem United’s The Nest Community Health Center is home to state-of-the-art dental facilities that include three treatment rooms and a panoramic X-ray. Led by dental director Dr. Alexandra Frankel, Harlem United’s dental team provided care to about 1,200 patients in 2024, more than half of whom were on Medicaid. The comprehensive services, which include dental cleanings, root canals, crowns, extractions, dentures, and emergency care, are critical to meeting the dental care needs of low-income, underserved populations in provider shortage areas, said Frankel.
Dental care is often treated “like a luxury when in reality, it should be something that should be able to be accessed by everybody,” she said.
Dental services are just one of the forms of comprehensive health care, alongside preventive primary care, behavioral health, and other vital services, offered at community health centers like Harlem United.
Harlem United’s Community Health Center is one of the many health centers affected by the Trump Administration’s cuts to federal health services. Credit: Elaine Sanders photo
New York state’s 70 community health centers serve more than 2.4 million people, nearly three-quarters of whom live at or below the federal poverty line, according to data from the Community Health Care Association of New York State. Offering discounted services based on patient income levels, the centers’ mission to deliver high-quality, affordable care to all is critical to the more than 50% of their patient population who are covered by Medicaid. Access to community health center services reduces patients’ needs for costlier care such as visits to the emergency department, hospitalizations, and specialty care, research shows.
The funding structure of community health centers has left many, however, facing financial difficulties.
Community health centers, also known as Federally Qualified Health Centers (FQHCs), are supported through a variety of sources, including the federal government, revenue from contracts with private insurance, reimbursements through Medicare, the federal insurance program for senior citizens and disabled individuals, and other government and private contracts, with Medicaid as their most significant source of funding. The program accounted for 44% of community health center revenue in New York State in 2024, according to data from KFF.
The Medicaid reimbursement rate is updated annually based on inflation, but these adjustments are simply not enough to cover the increasing costs of delivering health care, said Michaela Frazier, Ph.D., vice president of social support services at the Institute for Family Health, a community health center with sites in Manhattan, Brooklyn, the Bronx, and the mid-Hudson Valley.
“The reality is FQHCs are struggling,” she said. “Many of us are not meeting our budgets. We’re not being paid a sufficient rate to cover all of our services, especially when part of our mission … is to provide services regardless of people’s ability to pay.”
According to community health center audit data, half of community health centers had fewer than 90 days’ cash on hand, and one-quarter operated with margins below -4% in 2024.
The growing costs of dental care also make it challenging for community health centers to cover their expenses. Rising prices of dental equipment and supplies, as well as wages for dental staff, are outpacing inflation, according to a report published this year by the American Dental Association.
Dental health advocates also cite the significant provider expenses associated with dental care as contributing to fewer community health centers offering dental services. Currently, 82% of community health centers in New York state offer dental care compared to 96% that offer other specialty services such as mental health care.
Impact of new federal legislation on community health centers
Policy changes to Medicaid under the Trump administration’s legislation threaten the already fragile financial health of community health centers. The legislation, signed in July, imposes new Medicaid provisions such as changes in eligibility requirements, as well as more frequent recertification checks.
The modifications, to be phased in starting in late 2026 according to the bill, are expected to result in the loss of Medicaid coverage for millions of people, slashing a key source of revenue for community health centers and inundating them with scores of newly uninsured patients. In New York State, an estimated 1.5 million people are expected to lose their Medicaid coverage, tripling the number of uninsured people seeking care at the centers.
Harlem United’s Community Health Center is one of the many health centers affected by the Trump Administration’s cuts to federal health services. Credit: Elaine Sanders photo
“Health centers are already in trouble and this may just be what breaks them,” said Marie Mongeon, chief external affairs officer at the Community Healthcare Association of New York State.
Community health centers in the state are projected to lose more than $300 million annually, according to the group’s report. The decrease in revenue is likely to lead to the closure of some community health centers or reductions in service, said Mongeon.
Dental care is one of the community health center services at greatest risk of elimination, the report found.
“A lot of progress that we’ve gained … in engaging people in oral health care and overall health care … is going to be degraded,” she said.
For Sylvester Nunnery, who helps patients navigate dental insurance claim issues at Harlem United, the policy changes to Medicaid feel especially punitive. He questions the need for the revised eligibility guidelines that require Medicaid recipients to work, go to school, or volunteer for at least 80 hours a month, in a time of increased unemployment.
In addition, he said the legislation’s change to the Medicaid recertification process, which requires beneficiaries to submit paperwork confirming their program eligibility every six months, up from every 12 months, is an unnecessary barrier to care for low-income, underserved populations.
“For some people, it’s just sending in a form,” he said, noting that it is a significant disruption for others when they are already facing financial difficulties. “[It’s going] out of your way to spend four to five hours … to see someone for 10 minutes [who] tells you to go home and bring back these documents another day.”
A push to re-fund community health centers is the focus of the 2026–2027 legislative agenda of the Community Health Care Association of New York (CHCANY). The organization is engaging with policymakers to request the closure of the centers’ anticipated $300 million annual budget gap through updates to their Medicaid reimbursement rate.
Douglas York, Ph.D., president and chief executive officer of Union Community Health Center in the Bronx, believes that reinvestment in community health centers is the only path forward. For York, the value of Medicaid and the role of community health centers in safeguarding people’s oral health is clear.
“It keeps people healthier. It detects diseases and illnesses earlier. It prevents catastrophic illnesses later,” he said, “so it’s just logical that we make sure there is always a basic oral health benefit for patients in our communities.”
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