Medicaid Dental in New York

New York Medicaid pays for dental care that Medicare does not, like cleanings, fillings and dentures. You get it through regular Medicaid or through your plan. For bigger work, your dentist asks Medicaid to approve it first. Your county Department of Social Services decides who gets Medicaid. In New York City, that's the Human Resources Administration. A broken denture can make it hard to eat or talk.

For Medicare's own rules, see does Medicare cover dental.

You may qualify if

• You live in New York and have Medicaid, or can get it.
• You're 65 or older, and your income is under $1,856 a month, or $2,509 for a couple (2026).
• Your savings are under $33,038, or $44,796 for a couple (2026).

Not sure you qualify? Apply anyway, because the county makes the call and some of your income may not count. If you would rather not do it alone, a Pair Team advocate can check with you in one call.

What New York Medicaid dental covers

The New York State Department of Health lists these services. NY Health Access, a Legal Aid Society site, explains the details.

What changed for New York dental care in 2024?

Dental care changed in 2024 after a lawsuit, Ciaramella v. McDonald, ended in a settlement the court approved in October 2023. The new rules started January 31, 2024, for adults 21 and older. The state must keep them for four years.

• You no longer need a letter from your doctor for implants or replacement dentures. Your dentist's form is enough.
• A single implant can be covered when it's medically needed.
• Medicaid and plans may not turn down root canals, crowns, replacement dentures or implants by saying they aren't covered.
• If one of these was denied before 2024, ask your dentist to send the request again.

I have Medicare too. How do I get Medicaid dental care?

How you use Medicaid dental care depends on how you get your Medicaid.

• Regular Medicaid with Original Medicare: Go to a dentist who takes New York Medicaid.
• A Medicaid plan, like a long-term care plan: Use the plan's dentists, and call member services.
• A D-SNP: Since January 1, 2025, the state requires these plans to cover the full Medicaid dental benefit. There's no dollar cap. That includes plans for people who only have a Medicare Savings Program. One of these is Qualified Medicare Beneficiary (QMB).
• Dental school clinics: Medicaid plan members can use the clinics at five dental schools without prior approval, even outside the plan's network. They are Columbia, New York University, Stony Brook, Buffalo and Eastman Dental in Rochester.

The Health Insurance Information, Counseling and Assistance Program (HIICAP) is New York's free Medicare counseling. Its counselors (1-800-701-0501) can explain your plan choices. See Medicare and Medicaid together in New York for the limits and how to apply.

How to find a dentist

1. If you're in a plan, call the member services number on your plan card. Ask which dentists near you take it. Lists can be out of date, so call the office before you go.
2. With regular Medicaid, use the state's Medicaid Enrolled Provider Listing on health.ny.gov. In New York City, you can also call 311.
3. If no dentist has openings, your plan must refer you to one outside its network. With regular Medicaid, call the Medicaid Helpline at 1-800-541-2831 and ask for an out-of-network referral.
4. Let the dentist ask for approval. If it's denied, you get a written notice that says how to appeal.

Your rights if you are turned down

• A Medicaid dentist can't charge you more than the copay, the state says. The exception is if you signed a private pay agreement when treatment started.
• In a plan, ask the plan for an appeal first. If it still says no, ask for a fair hearing or an external appeal through the state Department of Financial Services.
• With regular Medicaid, ask for a fair hearing. Call 1-800-342-3334 or go to otda.ny.gov.
• For free legal help, call the Legal Aid Society's Access to Benefits helpline at 1-888-663-6880.

What a Pair Team advocate does

New Yorkers who call us about their teeth often have a broken denture, or a crown their plan said no to. New York has a shortage of dentists who take Medicaid, Legal Aid says. Finding one is often the hard part. This is what we do:

• Figure out how you get your Medicaid dental care, in one phone call.
• Find a dentist or dental school clinic that takes your coverage, and book the visit.
• Help you appeal a denial, or ask your dentist to resend it under the 2024 rules.
• Help with what usually comes with it: rides to appointments, food, utilities and housing.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Does New York Medicaid cover dental implants for seniors?

Yes, Medicaid covers implants when they're medically needed. Your dentist sends a state form that explains why a denture or other option won't work. One example the state gives is a person with Parkinson's disease who cannot manage a removable denture.

My dentures were lost or broken. Will Medicaid replace them?

Yes, Medicaid will replace them if your dentist fills out the state's Justification of Need form. It doesn't have to be notarized. If you need a second replacement within 8 years, the dentist must also explain how to prevent another loss.

I only have QMB. Do I get Medicaid dental care?

QMB does not give you dental care, because it pays Medicare costs. But New York does require D-SNPs to cover the Medicaid dental benefit for everyone in them. That includes people with only QMB. HIICAP can go over your choices with you.

My Medicare Advantage plan has dental. Will Medicaid pay too?

Yes, Medicaid pays for care it covers. Your Medicare plan pays first, and Medicaid pays last. Show your dentist both cards.

Should I see a dentist if I have no teeth?

Yes, a mouth exam can find early signs of cancer even if you have no teeth of your own, the state says. Medicaid covers the exam.

Sources

• Medicaid Member Dental Benefits, New York State Department of Health
• Dental Benefits Implementation Questions (D-SNP dental FAQs), New York State Department of Health
• Medicare Savings Program 2026, New York State Department of Health
• Expanded Medicaid Dental Benefits, Effective 1/31/24, NY Health Access (Legal Aid Society)
• What You Need to Know About In-Network Medicaid Dentists and Out-of-Network Referrals, Legal Aid Society
• Request a Fair Hearing, NYS Office of Temporary and Disability Assistance
• HIICAP, NYS Office for the Aging
• Medicaid, Medicare.gov