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New York State’s Medicaid coverage will expand to include dental procedures, including implants, root canals, and replacement dentures, after a group of New Yorkers filed a class action lawsuit against the state Department of Health. Previously, Medicaid only covered canal and crown treatments if the affected tooth was necessary to secure a denture or if it was medically impractical to remove. Replacement of broken or lost dentures was only covered if they were at least eight years old, and the implants were not covered at all. The expansion of Medicaid coverage is expected to improve the lives of low-income residents who couldn’t afford dental services.
Millions of New Yorkers can now get cheap or free dental care through Medicaid: program expanded
Medicaid coverage in New York State will expand to include dental procedures. This has long been sought by low-income residents of the region who could not afford the services of a dentist in America, writes The New York Times.
In 2018, a group of New Yorkers filed a class action lawsuit against the state Department of Health. They accused the agency, which oversees Medicaid in New York, of denying thousands of low-income New Yorkers the care they need. “Essential treatment” was defined as dental services.
The suit argued that healthy teeth are essential for both general physical health and psychological and social well-being, in particular, it is allegedly easier for people with healthy teeth to find and keep a job.
“You have to have teeth to function in our society,” said Belkis Garcia, a lawyer with the Legal Aid Society who filed the lawsuit. “Teeth affect everything in your life—your relationships, how people see themselves, how others see you.”
For decades, Garcia said, Medicaid recipients in New York could “pull out their teeth, but not fix them.”
“Once you have at least one tooth missing, all the teeth start to move,” said Victor Badner, head of the dentistry department at the Jacobi Medical Center. According to him, the removal of one tooth leads to a domino effect and the loss of other teeth.
On May 15, 2023, the Department of Health and plaintiffs reached an agreement. New York State Medicaid will now cover essential dental procedures, including implants, root canals, and replacement dentures.
New York Medicaid will now cover implants, replacement dentures, and most root canal treatments if approved by a dentist. A rule was also lifted that barred many procedures from being covered for people who still had four matching pairs of upper and lower back teeth. Previously, the state thought it was “sufficient for functional purposes.”
Under the old rules, Medicaid only covered canal and crown treatments if the affected tooth was necessary to secure a denture or if it was medically impractical to remove. Replacement of broken or lost dentures was only covered if they were at least eight years old. The implants were not covered at all.
On the subject: Medicaid Changes: What New Yorkers Need to Know
The main plaintiff, Frank Chiaramella, never learned about the victory in the lawsuit. The man died in 2020. In 2018, his dentures fell out when he sneezed and was hit by a car. Under the old Medicaid restrictions, he was not eligible for new dentures until 2024.
Medicaid expansion will improve lives
Matthew Adinolfi, 65, who has no upper teeth and hasn’t been on a date in over a decade, will now be able to get implants. He is sure that this will save his personal life, because he will be able to kiss a woman without fear that his dentures will fall out.
Adinolfi was disabled due to a back injury, so he uses Medicaid insurance. In 2010, all but three of his teeth were pulled out due to a mouth infection. Otherwise, it could spread to the internal organs.
“Either pull out his teeth or die,” is how he described the choice that the doctors put him in front of.
The dentures he received through Medicaid kept falling out, making it almost impossible to eat with them. He eventually paid for a permanent bridge for his lower front teeth, but he had no money for a second bridge. Years of using the upper gums to chew food has resulted in gum damage. Now he needs implants, but Medicaid didn’t cover them. But after the lawsuit is settled and the program expands, Adinofi will finally be able to get the implants.
He hopes that they will fix his personal life. The man has not been in a relationship for over 10 years.
“Because I just get to the point where I want to go to the next level, and then that’s it. If I pull out the prosthesis, you will notice how my cheeks are sunken. And if I do not pull it out, then it may fall out during a kiss. I was very embarrassed and uncomfortable because of this,” said Adinofi.
Now he has a girlfriend for the first time since his teeth were pulled out.
However, his path to dental functionality will be difficult. He has lost so much bone above his gum that he may need a bone graft from another part of his body or implants attached to his cheekbone. He will have months of operations and many hours in the dentist’s chair. But he is optimistic: “I can’t wait to get started!”
Blanca Coreas, who can’t eat anything harder than mashed potatoes without bleeding gums, can finally take a bite of grilled meat.
Coreas, 62, is one of the participants in the class action lawsuit. According to her lawyers, her dental problems led to indigestion, vitamin deficiencies, frequent mouth bleeding and depression. She said she isolated herself from society because people sometimes made fun of her appearance.
In 2019, when Medicaid denied a woman’s request for implants to effectively wear her dentures, she contemplated suicide: “I felt like I had no support from anyone.” But now everything will change for the better for her.
Lilian Velasquez has now had a root canal treatment she has denied herself for nearly five years.
Velasquez had his upper molar filled several times, but the filling kept falling out. Her dentist said she needed to clean and fill the root canal and put in a crown, but Medicaid would not have covered the procedure before. For years, Velasquez tried not to eat on her left side in order to preserve her fragile tooth.
Now she will finally be able to clean the canal and install a crown at the expense of Medicaid.
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