It’s a debate that is being waged across America, one that is essential to human health and well-being.
Are dental implants and other restorative dental services fundamental aspects of human health? Why should broken teeth be treated differently than broken bones when the ability to speak, to chew food, and even to breathe without obstruction are all vital to one’s physical and psychological well-being?
The misconception of restoring a mouthful of teeth that have been lost or distressed though disease, decay or a traumatic injury or accident as being a “cosmetic” or “aesthetic” matter has denied millions of the necessary care that is fundamental to one’s quality of life.
Now a class-action lawsuit has been settled that will bring about a change that is potentially transformative for five million adults in New York State who are on Medicaid, including implants, root canals and replacement dentures.
The suit, filed on behalf of five million patients who receive Medicaid insurance in the state of New York, charged the state with denying thousands of low-income New Yorkers medically necessary treatment.
While Medicaid programs can vary from state to state, under federal law, if a state Medicaid program does cover an optional category of care — such as dentistry, prescription drugs or optometry — it must cover all medically necessary care in that category.
The suit argued that dental health was essential not just to overall physical health but also to psychological well-being and the ability to find or keep 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. “It impacts everything in your life — your relationships, how people see themselves, how others see you.”
Under the old rules, root canals and crowns on back teeth were covered only if a diseased tooth was essential to anchoring a denture or if extracting it was medically inadvisable. Replacements for broken or lost dentures were covered only if the dentures were at least eight years old. Implants were not covered at all.
The suit’s lead plaintiff, Frank Ciaramella, died in 2020. In 2018, his dentures were destroyed after he sneezed; they fell out and were run over by a car. Under the old limits, he was not eligible for new dentures until 2024.
The dentures he received through Medicaid never fit and would not stay in place, making them impossible to eat with. He eventually paid for a permanent bridge for his lower front teeth, but could not afford one in back. Years of using his upper gums to chew down on his bottom denture have left the gums damaged. He needs implants to hold his upper denture in place, but Medicaid did not cover them.
The settlement obligates New York Medicaid to cover implants, replacement dentures and most root canals if a dentist authorizes the procedures.
The State Health Department, which twice attempted to get the case dismissed, said in a statement Monday afternoon that the settlement “recognizes the importance of oral health and affirms the state’s commitment” to people on Medicaid. [TBD]
