NYSDOH Settles Dental Medicaid Litigation

A federal class-action lawsuit brought against the New York State Department of Health (NYSDOH) on behalf of Medicaid recipients in New York who were denied coverage for medically necessary dental care was settled May 1 in favor of the recipients. The decision in the suit, which was originally brought in 2018, brings to an end  the strict limit that denied coverage for crowns and root canals to individuals with more than four pairs of teeth, an archaic policy not aligned with modern United States dental practice. Coverage for those procedures will now be approved for Medicaid recipients when deemed medically necessary, including for balance and function. 

The changes to the Medicaid dental benefit program mean added coverage for routine dental care and procedures to help Medicaid patients maintain better oral and overall health. The settlement will go into effect 90 days after the court’s approval.

The New York State Dental Association (NYSDA) supports the expanded coverage. In a statement released yesterday, we emphasized that dental health plays a vital role in overall health and that 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.

While NYSDA supports equitable care for all New Yorkers, we remain cautious about challenges that continue to exist that impact access to care for Medicaid populations. We recognize that the approval process for Medicaid is at times arduous due to a complex preauthorization process, and we also recognize that provider panels for some dental specialists are extremely limited. NYSDA has consistently advocated for easing the administrative burden on dentists to provide this care, and we have worked tirelessly to prevent reimbursement decreases and to even increase the Medicaid reimbursement rates.

In her Executive Budget, Gov. Kathy Hochul included strategic investments for programs that our state’s most vulnerable  residents utilize, including increased reimbursement rates for dental services to ensure access for all Medicaid members; increased Medicaid reimbursement for private practice dentists serving the developmentally disabled (IDD) population; and increased reimbursement for ambulatory surgery dental services for the IDD population. We certainly support these proposals, but will continue to advocate for greater focus on oral health care as an essential patient service and for more funding to all programs that improve oral health care for underserved populations.

Stay up-to-date on NYSDA advocacy efforts online at www.nysdental.org/advocacy