Good morning. There are people who really want root canals. We will be looking at a change in state rules that means they can now get them.
Five million New Yorkers are getting more dental coverage—Medicaid recipients who are now eligible for certain implants, replacement dentures and root canals that were previously denied and cost more than they could afford.
The change comes as the state agreed to a settlement in a class-action lawsuit filed in 2018 that had accused the state Department of Health, which oversees Medicaid in New York, of denying medically necessary treatments. The lawsuit argued that dental health is necessary not only for good physical health and psychological well-being. It even plays a role in job hunting.
My colleague Andy Newman has written that change has the potential to be both transformative and mundane. I asked him to talk about why — and what the settlement entails.
Why is this transformative?
Dental problems are some of the most common health conditions and although they are rarely fatal, they can be socially crippling – imagine trying to find a job or a romantic partner when most of your teeth are missing – and often affect your teeth. general health. And yet Medicaid, which provides health care to more than five million low-income adults in New York, did not cover many basic dental procedures.
The one who “fixes” this Medicaid I will coverage in most cases was exports. So in many cases where someone with decent private dental insurance would get a root canal or crown to save a damaged tooth, someone on Medicaid would end up just pulling the tooth.
That changes under this settlement.
Wasn’t New York’s Medicaid dental program already generous? Why had New York State denied dental care to low-income people on Medicaid?
Medicaid coverage is set by each state, and dental coverage ranges from none (for adults in Alabama) to quite extensive in other states. Colin Reusch, the policy director for the health care consumer advocacy group Community Catalyst, told me that New York already had one of the most generous Medicaid dental plans in the country.
However, there were gaps. Medicaid considers dentistry an optional category, but under federal law, if a state provides any coverage in an optional category, it must provide coverage for all medically necessary procedures in that category.
The Legal Aid Society, which filed the lawsuit that led to this settlement, argued that New York systematically denies coverage for medically necessary dental work. New York cut its Medicaid dental coverage for the same reason other states do: to save money.
A lawyer from the Legal Aid Society told you that New York’s rules were “structured to pull your teeth rather than save them.” If so, wouldn’t pulling one tooth endanger others?
Under the old Medicaid rules in New York, as long as you had four matching upper and lower pairs of back teeth, that was considered sufficient. So you could end up losing up to eight of your back teeth (in addition to your four wisdom teeth) before Medicaid starts covering procedures to save the rest.
One problem with this approach is that once a tooth’s neighbor is removed, the tooth can begin to move and drift, and then the problems multiply.
Will this begin to close racial disparities for some people?
Racial disparities in access to health care are one of the main drivers of the disparity in health outcomes and health shorter life expectancy for certain ethnic groups, especially blacks. Dental care is no different in this respect from other categories of health care. The Centers for Disease Control and Prevention found that black and brown adults suffer from untreated dental disease almost twice the rate of white adults.
People from ethnic minorities are more likely to be poor, and the poor are more likely to have inadequate dental care throughout their lives, so that later in life they are more likely to develop the kinds of problems that New York did not cover in past but from now on. These changes could help close the gap.
Put the changes on personal terms. What will they mean for someone with dental problems that Medicaid has refused to pay for in the past?
A plaintiff in the class action has been living with a horrible dental condition for years. His name is Matt Adinolfi. He is a former New York taxi driver, now retired and living in the mountains. Around 2010, he developed an infection that spread throughout his mouth.
He told me that root canals probably would have saved his teeth, “but I didn’t have that kind of money.” Doctors told him the infection was in danger of spreading to his organs. “At that point, it was either pull the teeth or die,” he said. So he had all of his teeth extracted except for three bottom front teeth, which in itself don’t do you much good.
Then one thing led to another. He got dentures through Medicaid, but they never fit properly. They would fall from their seats if he ate with them. He ended up with a denture attached to his remaining teeth on the bottom, but his upper mouth required implants to hold the denture in place, and Medicaid didn’t cover them. So he was taking his upper denture out to eat which meant his upper gums were hitting his lower denture and he developed gum problems.
And then there is the social aspect. On top of all the pain and suffering, he found it impossible to get into a romantic relationship because he would have to take out his floppy dentures before kissing someone, “and then you can notice how puffy I am in my face.” He stayed 10 years without a girlfriend because he couldn’t stand the embarrassment.
Adinolfi’s story really hit me. I had multiple root canals all covered by private insurance. Medicaid will now cover Adinolfi’s implants.
Weather
Get ready for more of the same. It will be breezy with showers and maybe thunderstorms and hail. The temperature will be around 50 degrees. Tonight, under mostly cloudy skies, temperatures will remain below average for early May – only in the mid-40s.
ALTERNATIVE PARKING
Valid until May 18 (Celebration of the Ascension).
New York breaking news
Dear Diary:
It was a warm spring evening in 2019. My boyfriend and I were walking in Brooklyn Bridge Park with another couple after dinner.
As we approached a bend I heard the song ‘Lovely Day’ by Bill Withers coming from a small picnic party. Every time I hear the song, it stops me in my tracks and fills me with emotion like I was that night.
A man with the picnic group approached us and asked if I was okay.
I told him that “Lovely Day” was my husband’s “theme song” when he was sick and that we had played it at his funeral.
The man took me by the hand, introduced me to the rest of his party, and told his friends about my singing story.
Suddenly, we were all dancing, hugging and singing together.
— Jan Testori-Markman
Illustrated by Agnes Lee. Submit submissions here and Read more Metropolitan Diary here.
