October 24, 2018

Class-action lawsuit will continue to proceed against New York State Department of Health on behalf of New Yorkers denied dentures and dental implants.

Willkie, in collaboration with Legal Aid, successfully secured a settlement with New York State’s Department of Health on a preliminary injunction motion filed on behalf of Frank Ciaramella, who was denied coverage for medically necessary replacement dentures and dental implants – a violation of the Medicaid Act, Americans with Disabilities Act and Rehabilitation Act. 

Pursuant to the settlement, Mr. Ciaramella should receive the medically necessary dental treatments that were the subject of the preliminary injunction motion. The agreement requires his Medicaid insurer to grant prior approval for the assessment and following procedures. If the insurer rejects the coverage, DOH agreed to pay for the treatment directly. The agreement also provides for the PI motion to be placed back on the calendar should the DOH not meet its obligations. 

Ciaramella and Richard Palazzolo, a Suffolk County resident also denied replacement dentures through Medicaid, first brought this suit on August 1 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 or restriction on coverage for certain services. The suit asserts that the rigid New York State Medicaid rules for dental coverage restrict coverage for services that are necessary for Medicaid recipients to maintain their overall health, a violation of federal law. The current NYS rules also ignore the close connection between poor oral health and other health problems suffered by the Medicaid-eligible population.

While Mr. Ciaramella’s preliminary injunction motion, for the time being, appears to have reached a favorable conclusion, the suit continues on as Willkie and Legal Aid work to ensure Mr. Ciaramella, and other Medicaid-eligible New Yorkers, have access to the care that they need. Additionally, though not a party to the PI motion, DOH also agreed to approve Medicaid funding for Mr. Palazzolo’s replacement dentures sought in the complaint.

The settlement was covered in a recent article in The New York Law Journal, “NY Medicaid Dental Coverage Lawsuit Continues Despite Settlement,” October 3, 2018.

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

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