By: Hadassa Kalatizadeh

A landmark settlement was reached, giving New York Medicaid patients expanded dental coverage.

As reported by the NY Times, on Monday a class action suit was settled giving some five million New Yorkers extended  insurance coverage for dental procedures including implants, root canals and replacement dentures.  The lawsuit, which had been filed in 2018 against the State Health Department, which oversees

Medicaid in New York State, had argued that the dental coverage was denying necessary treatment to thousands of low-income Medicaid customers.  The suit contended that dental health was essential for overall health, as well as psychological well-being and even the ability to hold a job.  “You need to have teeth to function in our society,” said Belkys Garcia, a lawyer with the Legal Aid Society, which filed the suit along with two other law firms. “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,” Garcia said.

Federal law does not mandate that state Medicaid programs should cover dental care, and in some states they don’t.  The law, however, stipulates that if a state Medicaid program does opt to include dental coverage, then it must cover all necessary medical care in that field.

Ms. Garcia says that for decades NY’s coverage plans were “structured to pull your teeth rather than save them.”  She added that since teeth also act as a bridge to hold neighboring teeth in place, one extraction can often lead to more teeth being lost.  “Once you start missing one tooth, the teeth start shifting,” said Victor Badner, chairman of dentistry at Jacobi Medical Center in the Bronx, who filed a declaration in the lawsuit describing the dental situation for one of the plaintiffs in the case.  Badner says that now, since the case’s victory “the vast majority of patients who otherwise would end up losing more teeth may instead be able to save them.”

As per the Times, in the past, root canals and crowns on back teeth were only covered by the plan if that tooth was essential to anchoring a denture or if extracting was medically ill-advised. Replacement dentures for broken or lost ones had only been covered if the dentures were eight or more years old. Implants were never covered at all.

The recent ruling also uproots a former rule which denied coverage for many procedures if the patient still had four matched upper and lower pairs of back teeth, which the state had “considered adequate for functional purposes.”

NYS’s Medicaid plan was already among the most generous in the country, according to Colin Reusch, director of policy for Community Catalyst, a health care consumer advocacy group.  NYS’s Health Department had twice attempted to get the case dismissed, fearing that the changes requested in the suit would lead to escalating costs, per the Times.  Overall, Medicaid recipients do tend to have more health problems than the greater population at large– many times because of lower standards of living and below par medical attention.   The Health Department commented Monday, saying that the settlement “recognizes the importance of oral health and affirms the state’s commitment” to patients on Medicaid.