Lawsuit Settlement Paves Way for Improved Dental Care of Medicaid Patients

Lawsuit Settlement Paves Way for Improved Dental Care of Medicaid Patients

Changes to dental benefit program also expected to result in cost savings to taxpayers

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

NYSDA has made known its support for the expanded coverage, noting in a public release that dental health plays a vital role in overall health and emphasizing that the Association 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, it remains cautious about challenges that continue to exist that impact access to care for Medicaid populations, among them, an approval process for Medicaid that is at times arduous due to a complex preauthorization system, and provider panels for some dental specialists that are extremely limited. It reminds its members and the public that it has consistently advocated for easing the administrative burden on dentists to provide this care, and has worked tirelessly to prevent reimbursement decreases and to increase the Medicaid reimbursement rates.

In her Executive Budget, Gov. Kathy Hochul included strategic investments for programs that the 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. NYSDA supports 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.

Changes to the Medicaid dental benefit program brought about by the May settlement are expected to result in long-term cost savings for New York State and its taxpayers by allowing Medicaid recipients to immediately address dental needs before they worsen and significantly impact overall health, requiring additional dental and/or medical attention.