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On May 5, 2016 Center for Medicare Advocacy executive director Judith Stein and Senior Attorney Wey-Wey Kwok, the Dental Lifeline Network, the Medicare Rights Center, and former CMS (then HCFA) administrator Bruce Vladeck, met with CMS officials to discuss coverage of medically necessary oral health care.

The group’s primary goal was to advance Medicare coverage for oral health care and clarify that CMS currently has legal authority to cover medically necessary oral health care.  Dr. Larry Coffee of the Dental Lifeline Network presented compelling descriptions of the medical necessity of oral health care, particularly for those in need of other significant interventions, like transplants, heart and cancer treatments.  Individuals needing medically necessary oral health care to deal with the after-effects of such treatment, or to care for infections were also discussed.  The Center supported these discussions with a petition containing thousands of beneficiary signatures, and comments from hundreds of those beneficiaries describing the necessity of such non-routine care to maintain their health.

In addition, the Center submitted a memorandum clarifying the difference between medically necessary oral health and routine dental care, and laying out Medicare’s existing legal authority to cover such services.  Possible models for opening coverage for medically necessary oral health care were also discussed.

CMS will review the legal issue brief we submitted, and our team will follow up with additional specific implementation ideas.

We are grateful to all those who signed our petition; you voices were heard, loud and clear.  Please watch for our follow-up efforts!

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