Medicaid Dental Benefit in NYS

Under Medicaid, dental benefits exist, but the coverage is limited. This limited coverage makes it important for advocates to understand the exceptions to different coverage limitations. By understanding the nuances of the benefit, advocates can help get their clients the coverage they need.

NEWS FLASH SEPTEMBER 2018:

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.  See article in New York Times, August 2, 2018, "Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says." In response, DOH will be implementing changes to the dental manual to cover dental implants when medically necessary and to change the rules for replacement dentures. These changes, described below and in this document, will take effect on November 12, 2018.  The new rule on replacement dentures imposes new documentation requirements and will be a step backward for some.

Legal Aid Society asks you to let them know if you are working with Medicaid-eligible individuals who require dental implants or replacement dentures, including those whose care may not be covered based on the revised policy.  They also want to speak with Medicaid-eligible individuals who require any other dental treatments that are not covered by Medicaid including root canals, immediate dentures, osseous surgery.   Contact: Legal Aid Society Health Hotline  (212) 577-3575 or email

Revised policy effective November 12, 2018 - click on these links:  

VI. Prosthodontics -  Full and /or partial dentures

 

VIII. Implant Services

 

WHAT DENTAL SERVICES ARE COVERED UNDER MEDICAID?

THE FOLLOWING DENTAL SERVICES ARE EXCLUDED UNDER MEDICAID AND WILL NOT BE REIMBURSED

WHAT IF MEDICAID DENIES THE CLAIM?

RELEVANT REGULATIONS


FAIR HEARINGS

COMMON ISSUES

The Fair Hearings described below were decided based on the OLD denture Policy, which expires Nov. 11, 2018.

MANY DENTAL CLINICS ARE COVERED UNDER MEDICAID



Article ID: 210
Last updated: 29 Nov, 2018
Revision: 16
Medicaid -> Medicaid Managed Care -> Medicaid Dental Benefit in NYS
http://www.wnylc.com/health/entry/210/