New York Medicaid to Expand Dental Coverage for 5M People

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US: A recent settlement in a class-action lawsuit filed in 2018 against the New York State Department of Health, which oversees Medicaid in New York, will allow five million low-income New Yorkers to receive better dental coverage. 

The lawsuit claimed that the state’s Department of Health had denied Medicaid recipients medically necessary dental treatments in the past, including some implants, replacement dentures, and root canals, which cost more than what they could afford. As a result, thousands of low-income New Yorkers were being denied dental care they needed.

Outdated Dental Health Program

According to the lawsuit, the dental health program in New York was outdated and stuck in the 50s and 60s. The state’s Medicaid program had a rule that stated only four pairs of back teeth in addition to front teeth were essential for functioning, which led to the denial of coverage for root canals and crowns, two of the most common dental procedures. The settlement now forces Medicaid to prioritize treating and keeping teeth that can be saved instead of extracting them.

The change will go into effect 90 days after the court’s approval, and the New York State Dental Association supports the expanded coverage. The association said that dental health plays a crucial role in overall health and that it is committed to advocating for access and expanded coverage for medically necessary procedures that significantly benefit the patient’s well-being.

Improving Oral Health for Low-Income Patients

The expansion of dental coverage is expected to dramatically improve oral health for low-income patients across the state. Dental care is not a federally mandated benefit, and Medicaid programs vary across states. A handful of states, including Alabama and Delaware, provide no dental coverage to adult Medicaid recipients, while approximately a dozen others offer care only in emergencies. However, states that provide the optional benefit must cover all medically necessary care.

Studies have shown deep racial and economic disparities in oral health, and efforts to address these disparities in adults have shown only limited progress, according to a report by the U.S. Centers for Disease Control and Prevention. The shift in New York’s rules comes at a crucial time, just as millions of adults who benefit from Medicaid nationwide are set to lose dental coverage when the national COVID-19 Public Health Emergency expires later this month.