For months, Carlton Clemons endured crippling pain from a rotting wisdom tooth. He couldn’t sleep, barely ate and relied on painkillers to get by.

The 67-year-old from Nashville, Tennessee, could not afford to see a dentist on the $1,300-a-month his family gets in Social Security and disability payments. So he waited for the state to roll out a program this year that offers dental care to the more than 650,000 Medicaid recipients like him who are 21 and older. Tennessee is spending about $75 million annually on the program.

“Man, I thought I had made it to heaven because the pain was over,” he said after the tooth was pulled in July at the Meharry Medical College School of Dentistry. “When they did pull it out, I was so happy. I was so glad. Everything just changed after that.”