New Medicaid Dental Coverage Rules

Oral health is essential to overall health. However, Medicaid coverage for dental services for adults in New York has historically been extremely limited. In 2023, The Legal Aid Society, Willkie Farr & Gallagher LLP, Freshfields Bruckhaus Deringer US LLP reached a settlement with the New York State Department of Health in Ciaramella v. McDonald, a class action challenge to New York’s Medicaid coverage rules for root canals, crowns, replacement dentures, and dental implants. The new coverage rules went into effect on January 31, 2024. This program begins with a brief introduction to issues in oral health care, oral health disparities, Medicaid concepts relevant to the issue, and the Ciaramella litigation. They also go through the new Medicaid coverage rules resulting from the settlement. It will also address the types of denials and barriers that have arisen since January 31, 2024, and appeal options for denials of this care.