Willkie and Legal Aid File Federal Class Action Lawsuit Against New York State for Denying Medicaid Recipients Necessary Dental Coverage

August 29, 2018

Litigation could potentially benefit thousands of low-income New Yorkers suffering From the state’s flawed and inadequate Medicaid dental program.

Willkie and The Legal Aid Society filed a federal class action lawsuit on August 1 against the New York State Department of Health on behalf of two low-income Medicaid recipients in New York who have been denied coverage for medically necessary dental care by New York State – a violation of the Medicaid Act, Americans with Disabilities Act and Rehabilitation Act.

Plaintiffs Frank Ciaramella and Richard Palazzolo brought this suit on behalf of thousands of Medicaid-eligible New Yorkers whose expenses associated with medically necessary dental services are not reimbursable by New York’s Medicaid program because of the Program’s categorical ban on dental implants and strict limits on replacement dentures. The suit asserts that the rigid rules in the NYS Medicaid Program Dental Policy and Procedures Code Manual restrict coverage for services that are necessary for Medicaid recipients to maintain their overall health. The current NYS rules ignore the close connection between poor oral health and other health problems suffered by the Medicaid-eligible population, including periodontal disease, gum disease, diabetes and related health complications.

This suit is the latest example of New York State’s Department of Health denying medically necessary care to Medicaid-eligible recipients. In 2015, for example, DOH was found to have violated the Medicaid Act by refusing medically necessary care to transgender Medicaid recipients in Cruz v. Zucker. Willkie and Legal Aid achieved this historic victory which secured transgender New Yorkers’ right to Medicaid coverage of medically necessary gender affirming treatment.

The case has garnered substantial press coverage, including:

Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says,” The New York Times, August 2, 2018

Medicaid Dental Coverage Challenge,” The Capitol Pressroom, WCNY, New York, August 20, 2018

The matter is being handled by partners Mary Eaton and Wesley Powell, senior counsel Bart Schwartz and associate Timothy Fleming.