What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS

By the Legal Aid Society

Thanks to a settlement secured by Legal Aid in Ciaramella v. McDonald many more New Yorkers will be eligible for additional dental procedures under Medicaid by early 2024.

What dental services does the settlement impact?

Root canals, crowns, dental implants, and replacement dentures for Medicaid enrollees over the age of 21.

When do the new rules go into effect?

The new rules are not in effect yet. The settlement is subject to court approval, but we expect that the new rules will be in effect by early 2024.

Can I be paid back for money I already spent out-of-pocket for these dental services?

When the new rules go into effect, they will only apply going forward. You will not be paid back for money spent out-of-pocket for services received before the new rules went into effect.

Should I delay treatment until the new rules go into effect?

We cannot advise on your individual health needs. Please speak with your provider about what your treatment options are. If you want further advice about whether the new rules may cover your current treatment plan, please contact The Legal Aid Society’s Access to Benefits helpline Monday through Friday 10:00 am to 3:00 pm at 888-663-6680.

I am a dentist who takes Medicaid. When will I get more information about how this settlement will impact my practice?

The settlement is subject to the court’s approval. After the settlement agreement is final, the State Department of Health (DOH) will provide a new Manual and Guidance document to dental providers via eMedNY.org. DOH will also provide a webinar for Medicaid managed care plans, dental providers, and others on the new policies.

I am a dentist who takes Medicaid. Can I refer my patients to Legal Aid?

Please refer patients who have denials or questions about Medicaid coverage to The Legal Aid Society’s Access to Benefits helpline at 888-663-6680. The helpline is open Monday through Friday 10:00 am to 3:00pm.

Disclaimer

The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.