Expanded Medicaid Dental Benefit in Effect as of 1/31/24

New York’s Medicaid program expanded coverage of dental benefits as of January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article provides detailed information about the expanded benefits. This article provides information about the rules that were in effect through 1/30/24, which still apply to services requested before 1/31/24. 

Background:

In August, 2018, The Legal Aid Society and Willkie Farr & Gallagher filed Ciaramella v. Zucker (18-cv-06945) to challenge the New York State Department of Health’s rules preventing Medicaid coverage for replacement dentures within 8 years from initial placement and the ban on Medicaid coverage for dental implants.  In response, DOH implemented changes to the dental manual to cover dental implants when medically necessary and to change the rules for replacement dentures. These changes, described here went into effect on November 12, 2018.

The case was amended to include a challenge the revised rules for Medicaid coverage for dental implants, replacement dentures and to add a challenge to Medicaid coverage rules for root canal and crowns.

On May 1, 2023, a motion for preliminary approval for a settlement agreement was filed. This Know Your Rights document provides basic information about the settlement.