ALBANY, N.Y. (WTEN) — Around five million New Yorkers using Medicaid will be getting expanded dental coverage. This is the result of a federal class action lawsuit against the Department of Health from 2018 resulting in a settlement.
“The New York Medicaid dental program has clinical standards that are really… stuck in the 50s and 60s,” said Belkys Garcia, a staff attorney at the Legal Aid Society who previously worked in the health law unit. She said many of her calls consisted of people being denied Medicaid for what seemed to be basic dental needs. “Like a root canal or a crown, what New York does instead is pull molar teeth. There’s no coverage, no Medicaid coverage for molar teeth, once you’re over 21 years-old and the thing to do in those cases is to try to change the rules,” she said.
The lawsuit claimed that thousands of low-income New Yorkers are being denied medically necessary dental care by New York State. Garcia said under current New York law, essential dental needs are based on something called the ‘dental Manual.’ “New York’s rule was that you only needed four pairs of back teeth in addition to your front teeth in order to function,” she said. But the settlement is now forcing Medicaid to focus on treating and keeping teeth that can be saved rather than extracting them.
The New York State Dental Association supports the expanded coverage and in a statement, said in part: “Dental health plays a vital role in overall health. NYSDA is committed to advocating for the prioritization of access and expanded coverage for medically necessary procedures that significantly benefit the patient’s well-being.” The settlement will go into effect 90 days after the court’s approval.