Includes implants, replacement dental prosthetic appliances, crowns and root canals as medically necessary dental care and services for coverage under the Medicaid program if a qualified dentist authorizes the procedures.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1931REVISED 5/29/26
SPONSOR: Paulin TITLE OF BILL:
An act to amend the social services law, in relation to including dental
implants, replacement dental prosthetic appliances, crowns and root
canals as medically necessary dental care and services for coverage
under the Medicaid program
PURPOSE:
To ensure that medically necessary dental care including crowns,
dentures, implants, and root canals remain covered under the State's
Medicaid Program.
SUMMARY OF PROVISIONS:
Section one amends section 365-a of the social services law to add a new
paragraph f-1 requiring dental implants, implant-related services,
dental prosthetic appliances, replacement dental prosthetic appliances,
crowns and root canals for posterior and anterior teeth, crown lengthen-
ing when associated with a covered crown and/or root canal to be
included under the definition of "standard coverage," requiring New York
Medicaid to provide coverage for these services when medically neces-
sary.
Section 2 provides the effective date.
JUSTIFICATION:
In 2018, a class of low-income New Yorkers brought suit against the
Department of Health, alleging that New York Medicaid's categorical ban
of implants and limits on replacement dentures, root canals, and crowns,
violated the Medicaid Act, the ADA, and the Rehabilitation Act (Ciara-
mella v. McDonald). This class action was comprised of individuals who
had been denied medically necessary dental treatment by Medicaid, and in
many cases, were forced to have their teeth removed rather than repaired
or go without implants or dentures.
Ultimately, Ciaramella was settled via a stipulation agreement which
took effect on January 31, 2024. Through this agreement, the Department
of Health was required to ensure that New York Medicaid would provide
insurance coverage for medically necessary dental procedures including
dentures, implants, crowns, and root canals, so long as they are author-
ized by a licensed dentist. However, the provisions of the stipulation
agreement are only mandatory for four years, as the termination date is
set for January 21, 2028.
Absent legislation to ensure that New York Medicaid continues to cover
these critical dental services, there is no obligation for New York
Medicaid to continue requiring coverage. Instead, we will be at risk of
returning to the previous coverage rules for Medicaid, which resulted in
the barbaric practice of pulling teeth from low-income New Yorkers who
could not afford to pay for alternative treatment out-of-pocket and, in
many cases, forcing those who have lost teeth to go without necessary
implants or dentures. Further, the loss of teeth often compounds to
additional dental, physical, and mental health issues. Consequently, any
cost savings that may come to the state from denying coverage for these
services is more than lost by the additional strain that is put on our
state's medical system from emergency room and other treatment resulting
from barring low-income New Yorkers from proper dental care.
Dental health is important for everyone. With the termination date for
Ciaramella v. McDonald approaching, it is imperative that the legisla-
ture take action to ensure that New Yorkers maintain access to crucial
dental services. This bill will ensure that medically necessary dental
services remain covered for Medicaid patients, in recognition that no
person in New York should be forced to lose their teeth or go without
replacement because of their economic status.
PRIOR LEGISLATIVE HISTORY:
A.8983 of 2024, ordered to third reading;
S.7667a of 2023-2024, passed Senate.
FISCAL IMPLICATIONS:
No additional costs.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become law.
