Ensuring Access to Expanded Dental Coverage for New Yorkers

Grantee Name

Legal Aid Society

Funding Area

Special Projects Fund

Publication Date

February 2026

Grant Amount

$150,000

Grant Date:

January 2024

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Inadequate dental care and poor oral health are linked to a range of physical, psychological, and quality-of-life issues. Tooth decay and loss, gum degeneration, and mouth infections—when left untreated—can increase the likelihood of conditions like heart disease, diabetes, respiratory ailments, and malnutrition. New York State is 1 of 14 states that offer extensive dental benefits under Medicaid as an optional covered service, but it has historically limited coverage of dental implants, replacement dentures, root canals, and crowns. New York State’s Medicaid program recently expanded coverage for dental services to address this gap in care. While the policy change is a big win, its impact depends on recipients, dentists, and advocates understanding the rule changes and recipients’ rights. In 2023, NYHealth awarded the Legal Aid Society (LAS) a grant to provide education and technical assistance to dentists and consumer advocates to ensure they understand the Medicaid rule changes, patients’ rights, and how to access newly covered services.

Under this grant, Legal Aid Society educated patients, dentists and advocates about the new coverage rules and assisted individuals who were denied healthcare coverage. The work also showed where the system still needs improvement, helping build a path toward better dental care for people who rely on Medicaid.

Outcomes and Lessons Learned

- Created easy-to-use Know Your Rights (KYR) materials helping Medicaid recipients understand their rights and options when coverage is denied. Legal Aid Society’s primary KYR resource received nearly 2,740 views.
- Hosted multiple in-person trainings to increase awareness of changes with more than 630 participants, including providers, advocates, and community members, that attended.
- Provider outreach exposed significant implementation failures. A statewide education campaign to Medicaid dental providers revealed that State provider lists were outdated and that many listed providers no longer accept Medicaid, limiting beneficiaries’ ability to use newly covered services.
- Monitoring client cases and fair hearing decisions showed that Managed Care Organizations (MCOs) and administrative law judges frequently misapplied or ignored the new rules, often relying on outdated standards. COVID-related backlogs delayed hearings for months, slowing enforcement and limiting early outcome data.

During the grant period, Legal Aid Society opened nearly 200 dental access cases, underscoring that policy change alone was insufficient to ensure timely access to care. Legal Aid Society shifted strategy toward external appeals, which require clinical review by medical professionals and resulted in higher success rates for securing coverage for complex dental procedures, a key lesson for future enforcement efforts.

Co-Funding and Additional Funds Leveraged: N/A

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