Legal settlement takes a bite out of dental costs for 5 million New Yorkers on Medicaid
Roughly 5 million New Yorkers will be able to get Medicaid coverage for root canals, replacement dentures, dental implants and other vital dental procedures, as part of a settlement in a federal class action lawsuit.
The new rules offer a lifeline for patients like Matthew Adinolfi, 65, a former city yellow cab driver who’s had to deal with social embarrassment, depression and escalating health issues after he had his teeth revamped to stop a fast-spreading infection in 2010.
“I had a social life that I stopped going to,” Adinolfi told the Daily News.
His dentures never fit properly and he can’t chew food so that means awkward conversations any time he goes out to dinner with a friend about what he’s ordering, choking scares and embarrassing conversations with potential dates.
“Hey, we’re getting to know each other more, and then boom, I’d take it to a certain spot and I wouldn’t pursue it, you know?” he said. “It was just very frustrating for me a lot of different ways outside of medically.
“It’s now because also a medical issue, because I’ve lost so much bone,” Adinolfi added. “My gums have been worn down.”
Under the terms of the settlement announced Monday, the state can no longer deny crown and root canal coverage to people with more than four pairs of back teeth touching — a restriction that required such patients to have their infected or abscessed teeth pulled, instead.
The settlement also lifts the ban on crown lengthening and dental implant coverage, as well as the strict limits on replacement dentures — allowing patients to get coverage if the procedures are deemed medically necessary.
The Legal Aid Society, which represented the class action clients in Manhattan Federal Court, described the new rules as “landmark changes” to the state’s Medicaid laws that provide important care and basic dignity to indigent people who otherwise wouldn’t be able to afford dental work.
“With this settlement, millions of New Yorkers on Medicaid across the state will now have access to insurance covering a range of dental issues central to maintaining one’s overall health,” said Legal Aid Society staff attorney Belkys Garcia.
“Anyone can appreciate that inadequate dental care leads to unemployability, social isolation and medical complications,” said Mary Eaton, a partner at Freshfields Bruckhaus Deringer US LLP, which along with Willkie Farr & Gallagher LLP also represented the class action clients.
The Manhattan Federal Court suit was initially filed against the state Department of Health by two men in 2018.
Frank Ciaramella, a Staten Island resident suffering from end-stage renal disease, getting all of his teeth removed, was denied coverage for dental implants. He couldn’t get replacements for a set of upper dentures that were run over by a car and smashed.
Richard Palazzolo, of Suffolk County, had to live in a homeless shelter after his father died in 2015, then moved to supportive housing — where his lower dentures were stolen along with other items in 2017. He got those dentures a year earlier, but Medicaid wouldn’t replace them because the rules only allowed for replacements every eight years.
Nine more plaintiffs joined the lawsuit with similar stories of pain, inability to eat properly and depression. Four of the plaintiffs did not live to see the settlement, including Ciaramella, who died in December 2020.
Adinolfi, who now lives in Essex County, N.Y., said he joined the lawsuit after seeing a newspaper article about it and saw it as a chance to get the help he needs.
“It’s five, six years we’ve been working on this case,” Adinnolfi said. “I’m really happy, because there’s a lot of people that this is going to benefit, you know?”
He’s now looking for a medical provider that can do the complex work of bone grafting, implants and implant-supported dentures.
In a written statement Sunday, state Department of Health spokesman Cort Ruddy said, “New York State’s Medicaid program provides comprehensive health coverage to more than 7.3 million New Yorkers. This settlement recognizes the importance of oral health and affirms the state’s commitment to those individuals.”