Ensuring Access to Expanded Dental Coverage for New Yorkers
Special Projects Fund
December 8, 2023
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. Beginning in 2024, New York State’s Medicaid program will provide coverage that better reflects current standards of care and a comprehensive dental benefit. 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, LAS will develop educational materials, provide in-person and virtual trainings, and monitor the rollout of expanded coverage. In consultation with the New York State Department of Health (NYSDOH), LAS will create training materials to inform dental clinic staff and Medicaid managed care plans about the new Medicaid coverage. The materials will provide clear information about how to interpret and implement the new rules, submit for coverage, and seek legal assistance for patients and what to do if Medicaid denies coverage. LAS will conduct training for all dental sites that serve Medicaid patients. It will partner with consumer advocacy groups and social service providers to raise awareness about expanded coverage and information about New York State’s dental provider network, and it will disseminate educational materials through a series of webinar trainings, media, and dental conferences. LAS will track and monitor information on the number and types of technical assistance requests and fair hearing topics and decisions. It will work closely with NYSDOH to create a feedback loop to share trends and information. NYSDOH will incorporate these findings into its ongoing training and oversight of Medicaid managed care organizations. LAS will operate its Access to Benefits helpline to respond to questions about coverage from providers and patients. It will also provide Medicaid recipients guidance on requesting hearings and appeals to challenge Medicaid denials of newly covered dental services.