The Legal Aid Society, Willkie Farr & Gallagher LLP, and Freshfields Bruckhaus Deringer LLP announced a historic settlement in Ciaramella v. Zucker – a federal class action lawsuit brought against the New York State Department of Health (DOH) on behalf of Medicaid recipients in New York who were denied coverage for medically necessary dental care by New York State.

The settlement will affect roughly five million individuals statewide, as reported by The New York Times. Most significantly, it ends the strict limit denying coverage for crowns and root canals to individuals with more than four pairs of teeth, an archaic policy not aligned with modern US dental practice. Coverage for those procedures will now be approved for Medicaid recipients when deemed medically necessary. Changes to the benefit program focus on added coverage for routine dental care and procedures, to help Medicaid patients preventatively maintain better oral and overall health.

“I did not want to go out in public or talk to people, and sometimes I would snap. I didn’t want anyone to see me,” said plaintiff Brenda Perry reflecting on her own serious dental issues. “It felt like I was physically and mentally breaking down.”

“It took me 5 years, but I finally got some help, and my life has changed so much since then,” she continued. “Now, I can eat everything, I go out, and I’m not as shy, I talk to customers. I’m much better now, but I wouldn’t wish what I went through on anyone.

“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 Belkys Garcia, an attorney with the Civil Law Reform Unit at The Legal Aid Society.

“We brought this lawsuit to end New York’s long standing practice of denying our clients medically necessary care and will continue to do so as long as these injustices remain on the books,” she continued. “The Legal Aid Society lauds our Plaintiffs for their bravery and work on behalf of millions of New Yorkers to elevate this issue.”

New Yorkers will be eligible for additional dental procedures under Medicaid as of January 31, 2024. Learn more.