Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says

NEW YORK — Frank Ciaramella has not been in a family photo in years, and he also cannot remember the last time he had good veal scaloppine.

Without any teeth, Ciaramella, a Staten Island resident, faces a host of challenges, but he said his most pressing concern is his inability to chew food. As a result, he said he cannot follow a prescribed diet related to his end-stage renal disease, and he’s at risk of being too overweight for a much-needed kidney transplant.

Though dentures seemed to be the solution, Ciaramella, who qualifies for Medicaid, said he has run into a litany of problems since he received them in 2016. He said his bottom dentures never fit properly because of bone erosion, a problem dental implants could rectify, but Medicaid does not cover that procedure. Then, a few months ago, he said his top dentures fell out and were run over by a car, and Medicaid will not pay for a replacement until 2024.

Now, Ciaramella, 57, is one of the lead plaintiffs in a class-action suit filed Thursday in U.S. District Court in Manhattan against the New York state Department of Health for the Medicaid program’s categorical ban on dental implants and limits on replacement dentures. The Legal Aid Society and Willkie Farr & Gallagher filed the suit, saying the state is denying medically necessary treatments for thousands of low-income New Yorkers.

“I would agree that there are cases where getting a single dental implant for a particular person may not be necessary, but people like Mr. Ciaramella, that’s not the case here,” said Belkys Garcia, a lawyer for the Legal Aid Society. “For him, this is medically necessary, and it’s having a real dire impact on his health and really putting his health in danger.”

The federal government provides some funds to states that participate in the Medicaid program, and states have to follow certain federal rules. The Health Department oversees New York’s Medicaid program, and it has some flexibility to determine which care is deemed medically necessary.

The Health Department declined to comment on pending litigation.

“While this case is really about getting people like Frank the access to medically necessary dental care that they need, it’s also to continue taking on categorical bans generally in the hopes that the practice dies out eventually,” said Wesley R. Powell, a lawyer for Willkie Farr & Gallagher.

Ciaramella’s struggles with dentures have also exacerbated his other health problems, including hypertension, coronary artery disease, diabetes and protein malnourishment, according to the lawsuit. His biggest concern, though, is a kidney transplant. Already on dialysis three times a week, he is on the waiting list for a kidney, which can take seven to 10 years, but he said his doctors told him he could not weigh more than 270 pounds. He currently weighs 294 pounds.

“I’m supposed to be high on proteins,” he said. “You can’t break down lettuce. I can’t chew vegetables. It’s hard to gulp it down. Financially, I can’t afford all those food processors to make everything into liquid.”

Dialysis also limits the amount of liquids he can drink each day, Garcia said.

As a result, Ciaramella’s diet is carb heavy: pasta with butter or marinara sauce, mashed potatoes and white bread, but only after he removes the crust and softens it by soaking it in milk.

The other plaintiff in the suit, Richard Palazzola, 60, received lower dentures in 2016. However, they were stolen in 2017, and Medicaid denied his replacement request because of the eight-year waiting period that the state’s Medicaid program requires for new dentures.

Palazzola, a Long Island resident, has a number of medical and mental health issues, including bipolar disorder, depression, anxiety and diabetes, according to the lawsuit. Without a full set of teeth, he is only able to eat soft foods, and he worries about his appearance, which has worsened his depression, the lawsuit says.

Ciaramella, who formerly worked as a truck driver, similarly spoke of the social repercussions of not having teeth. In addition to missing years of family photos, he said he often stays inside for fear of being ridiculed.

“It’s embarrassing,” he said. “I’m not a vain man, but when you look like a clown, everyone thinks you’re making faces. It’s just not an appealing thing. It ruins your social life.”