Five Million New Yorkers to Receive More Dental Coverage Thanks to Lawsuit

A class-action lawsuit won on May 1 by Medicaid recipients across New York will expand Medicaid access to medically necessary dental care, allowing more teeth to be saved rather than pulled.

Crowns and root canals were often denied to New Yorkers with more than four pairs of teeth – eight or more back teeth touching. Additionally, dental implants and related treatments were not always considered medically necessary, and replacement dentures were not always covered.

As Medicaid programs differ from state to state, and are not required to cover dental care, the lawsuit brought to light a federal mandate requiring all medically necessary care in optional categories of care, such as dentistry, to be covered by state Medicaid programs that cover optional categories of care.

Looking forward, root canals will be covered under New York Medicaid plans if the endodontist attests they are needed to help a patient maintain a “balanced and functional bite.” More coverage will also be made available as well, allowing patients access to replacement dentures, crowns and preventative dental care, supporting better oral health overall before problems become severe.

The ruling is a significant victory for patients and oral healthcare. It occurred days before the AAE’s annual meeting, AAE23, and on the first day of the AAE’s Save Your Tooth Month awareness campaign.

The AAE looks forward to working with New York Medicaid policy makers to ensure access to endodontic care becomes more accessible and that reimbursement rates are adequate.