Legal Aid Society

A Day In The Life

Securing Dental Coverage for Millions in the Civil Law Reform Unit

As a staff attorney in The Legal Aid Society’s Civil Law Reform Unit, Belkys Garcia handles cases that seek to expand low-income New Yorkers’ access to health care. They often take years to resolve, and clients don’t typically receive a financial settlement, but her clients are eager to keep what happened to them from happening to others.

They’re really invested in the possibility of being involved in systemic change and that willingness to share their stories and continue to work on things motivates me and brings me moments of joy.

Belkys joined The Legal Aid Society as a staff attorney in the Bronx Neighborhood Office in 2007 and later moved to the Civil Law Reform Unit, where she currently specializes in healthcare law, usually involving Medicaid recipients. One of her latest cases Ciaramella v. McDonald, recently expanded dental coverage under Medicaid to over 5 million New Yorkers, thanks to pro bono co-counsel Willkie Farr & Gallagher LLP and Freshfields Bruckhaus Deringer.

The class action case was filed on behalf of Frank Ciaramella and other Medicaid recipients in similar situations in 2018. Frank had no teeth, lost his dentures, and needed dental implants to hold new dentures. He stayed with the case until his death in 2020, and though he never got the steak dinner Belkys promised him due to the pandemic, he was able to get the medically necessary dental work he needed to eat the foods he enjoyed.

Under the settlement, New York State will now provide medically necessary dental coverage to those enrolled in Medicaid for root canals, crowns, replacement dentures, and dental implants – ensuring everyone gets the dental care they need.

Previously, New York followed the “eight points of contact” rule, which states so long as a person had four pairs of natural or prosthetic teeth in the back of their mouth touching, people needing root canals and crowns would instead have their teeth pulled.

The ensuing health complications from this practice ranged from the loss of more teeth and expedited bone erosion in the jaw requiring more invasive procedures like dental implants down the road to clinically dangerous weight loss and protein malnourishment. Belkys witnessed the health complications people like Frank were experiencing, and the societal implications of having missing teeth which pose barriers to employment, self-esteem, and overall life satisfaction.

Under the recent settlement, this archaic rule no longer applies to root canals and crowns.

The settlement affects any New Yorker enrolled in Medicaid who is over 21 years old, not just the typically older demographic associated with dentures. “I’ve had clients in their twenties who were forced to have their teeth pulled because of the Medicaid rules and who have to get dentures at such a young age,” she says.

These new changes go into effect on January 31, 2024, but Belkys knows from her work expanding Medicaid’s coverage for transgender New Yorkers and gender-affirming treatment that rolling out major changes to health insurance coverage does not always go smoothly. She will be shifting her energy to educating her clients, training other advocates and providers, and making sure that any court denials for previously uncovered medically necessary dental services are appealed.

Belkys will continue to hold New York City and State accountable and ensure that everyone on Medicaid gets the treatment they deserve.

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