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Landmark settlement expands dental coverage for New Yorkers with Medicaid
By
Brittany Kriegstein
Published May 1, 2023
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Aleksandr Rybalko/Shutterstock
By
Brittany Kriegstein
Published May 1, 2023
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New Yorkers now have one more thing to smile about.
A historic settlement announced Monday will greatly expand dental coverage to New Yorkers with Medicaid, making it easier to afford crowns, root canals, dentures and routine preventative care.
The Legal Aid Society, along with law firms Willkie Farr & Gallagher and Freshfields Bruckhaus Deringer, helped secure the changes as part of a settlement in Ciaramella et. al. v. Bassett, a federal class-action lawsuit brought against the New York State Department of Health (DOH) in 2018 on behalf of Medicaid recipients in New York who were denied coverage by the state for medically necessary dental care.
Under the old policy, New Yorkers with more than four pairs of teeth — eight or more back teeth touching — could have been denied coverage for crowns and root canals. In a press statement, the Legal Aid Society called that limit “archaic,” and said it is not aligned with modern dental standards in the U.S.
Additionally, replacement dentures were not always deemed as medically necessary, and coverage for dental implants and related treatments was banned.
Those restrictions will be eliminated as part of the settlement, lowering the threshold for New Yorkers trying to access such procedures. Now, crowns and root canals will be covered under Medicaid if they are needed to help a patient maintain a “balanced and functional bite.”
More coverage will also be added to help patients access preventative dental care, supporting better oral health overall before problems become severe.
“With this settlement, millions of New Yorkers on Medicaid across the state will now have access to insurance covering a range of dental issues central to maintaining one’s overall health,” said Belkys Garcia, staff attorney with the Civil Law Reform Unit at The Legal Aid Society. “We brought this lawsuit to end New York’s longstanding practice of denying our clients medically necessary care, and will continue to do so as long as these injustices remain on the books.”
The changes could help five million people across the state.
Tagged
new york state
medicaid
new york city
dental
health
Brittany Kriegstein
Brittany Kriegstein covers all breaking news around New York City, with a focus on crime and gun violence. Got a tip? Email Brittany at [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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