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Good morning. There are people who actually want root canals. We’ll look 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 some implants, replacement dentures and root canals that had been denied in the past and that cost more than they could afford.
The change is coming about because the state agreed to a settlement in a class-action lawsuit filed in 2018 that had accused the state’s Department of Health, which oversees Medicaid in New York, of denying medically necessary treatments. The lawsuit argued that dental health is essential not just to good physical health and psychological well-being. It even plays a part in job hunting.
My colleague Andy Newman wrote that the change has the potential to be as transformative as it is mundane. I asked him to talk about why — and what is involved in the settlement.
Why is this transformative?
Dental problems are some of the most common health ailments around, and though they’re seldom fatal, they can be socially crippling — imagine trying to find a job or a romantic partner when you’re missing most of your teeth — and often affect your overall health. And yet Medicaid, which provides health care to over five million low-income adults in New York, did not cover many basic dental procedures.
The one “fix” that Medicaid would cover in most cases was extractions. So in many situations where someone with decent private dental insurance would get a root canal or a crown to save a damaged tooth, someone on Medicaid would end up simply getting the tooth pulled.
That changes under this settlement.
Wasn’t New York’s Medicaid dental program already generous? Why had New York State denied dental treatment to low-income people on Medicaid?
Medicaid coverage is set by each state, and coverage for dentistry ranges from none at all (for adults in Alabama) to fairly 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 more generous dental Medicaid plans in the nation.
Still, there were gaps. Medicaid considers dentistry an optional category, but under federal law, if a state provides any coverage in an optional category, it has to provide coverage for all medically necessary procedures in that category.
The Legal Aid Society, which filed the suit that led to this settlement, argued that New York routinely denied coverage of medically necessary dental work. New York limited 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 that’s so, can’t pulling one tooth endanger others?
Under the old Medicaid rules in New York, as long as you had four matched upper-and-lower pairs of back teeth, that was considered adequate. So you could end up losing up to eight of your back teeth (in addition to your four wisdom teeth) before Medicaid would start covering procedures to save the remaining ones.
One problem with this approach is that once a tooth’s neighbor is removed, the tooth can start 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 in the difference in health outcomes and in shorter life expectancy for some ethnic groups, particularly Black people. Dental care is no different from other categories of health care in this regard. The Centers for Disease Control and Prevention found that Black and brown adults suffer from untreated dental disease at nearly twice the rate as white adults.
People from ethnic minorities are more likely to be poor, and poor people are more likely to have had inadequate dental care their whole lives, so that later in life they are more likely to develop the kinds of problems that New York did not cover in the past but will from now on. These changes could help close the gap.
Put the changes in personal terms. What will they mean to someone with dental problems that Medicaid had refused to pay for in the past?
One plaintiff in the class action suit has lived with a horrible dental situation for years. His name is Matt Adinolfi. He’s a former New York City cabby who’s now retired and lives upstate. 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 out or die,” he said. So he had all his teeth extracted except for three bottom front teeth, which by themselves don’t do you a whole lot of good.
Then one thing led to another. He got dentures through Medicaid, but they never fit right. They would fall out of place if he ate with them. He ended up with a denture cemented to his remaining teeth on the bottom, but for his upper mouth, he needed implants to hold the denture in place, and Medicaid wouldn’t cover them. So he would take his upper denture out to eat, which meant his upper gums were banging on his lower denture, and he developed gum problems.
And then there’s the social aspect. Apart from all the pain and discomfort, he found it impossible to get into a romantic relationship because he would have to take out his floppy top denture before he would kiss someone, “and then you can notice how sucked-in my face is.” He went 10 years without a girlfriend because he couldn’t handle the embarrassment.
Adinolfi’s story really hit home for me. I’ve had many root canals that were all covered by private insurance. Now Medicaid will cover Adinolfi’s implants.
Weather
Prepare for more of the same. It’s going to be breezy with showers, and maybe thunder and hail. The temperature will be in the mid- to high 50s. Tonight, under mostly cloudy skies, temperatures will remain below average for early May — only in the mid-40s.
ALTERNATE-SIDE PARKING
In effect until May 18 (Solemnity of the Ascension).
The latest New York news
Dear Diary:
It was a warm spring evening in 2019. My boyfriend and I were walking through Brooklyn Bridge Park with another couple after dinner.
As we came around a bend, I heard the song “Lovely Day” by Bill Withers coming from a small party of picnickers. Whenever I hear the song, it stops me in my tracks and I am filled with emotion as I was that evening.
A man with the picnic group approached us and asked whether I was OK.
I told him that “Lovely Day” had been my husband’s “theme song” when he was sick and that we had played it at his funeral.
The man took my hand, introduced me to the rest of his party and told his friends about my history with the song.
Suddenly, we were all dancing, hugging and singing along.
— Jan Testori-Markman
Illustrated by Agnes Lee. Send submissions here and read more Metropolitan Diary here.
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