Does the WTCHP Cover Dental Care?

The World Trade Center Health Program (WTCHP) does not provide stand-alone coverage for routine dental care. However, it does cover dental treatment when the care is medically necessary and related to a certified 9/11-related health condition—most often when dental complications arise from cancer or its treatment. Because of this distinction, dental benefits under the WTCHP can be confusing: cleanings, fillings, and routine dental work are not covered, but dental procedures that are part of treating or managing a certified cancer or its side effects may be eligible.

Below, we explain who may qualify for these limited dental benefits, what dental services are and are not covered, and what options exist for additional dental care support.

Overview of Coverage Under the WTCHP

The WTCHP, established under the James Zadroga 9/11 Health and Compensation Act, provides medical care for responders and survivors with certified 9/11-related health conditions. The program covers a wide range of illnesses, including cancers, respiratory diseases, aerodigestive disorders, and mental health conditions such as post-traumatic stress disorder (PTSD).

While the program provides comprehensive medical and mental health services, dental care is not included as a standard benefit. The WTCHP focuses on conditions that are linked to 9/11 exposure, and general dental health is not considered a covered condition under its current guidelines.

That said, coverage is provided for patients when medically necessary and related to a 9/11-certified condition. It’s important to note that the WTCHP doesn’t cover all dental care for these patients, but has specific, limited services that are covered.

What Dental Care Does the WTCHP Cover?

Most dental services are only available before cancer treatment and/or organ transplant, with the exception of members certified with WTC-related head/neck cancer, who may receive post-treatment dental care if medically necessary and needed due to WTC-related treatment. 

Covered services prior to treatment for any certified WTC-related cancer or prior to a WTC-related organ transplant include:

• A dental exam (once-per-lifetime) for eligible members, which may include a cleaning and all appropriate x-rays; and
• follow-up medically necessary dental care (such as deep cleaning, fillings, and extractions) before the organ transplant and/or the start of chemotherapy or radiation.
  
  

In these cases, the WTCHP coordinates with treating physicians and dental specialists to ensure the care is directly related to the certified health condition.

Eligibility for Dental Care Coverage Under WTCHP

Coverage was updated in 2023 to expand the specific situations where dental services may be approved. These now include:

• Patients with a WTC-related head/neck cancer 
• Patients receiving treatment for any 9/11-related cancer
• Patients with a planned WTC-related organ transplant
• Medically necessary dental care related to other certified WTC-related health conditions is considered on a case-by-case basis
  
  

Each case is reviewed individually to determine whether the dental service meets program criteria. Patients cannot receive reimbursement for dental services obtained outside the WTCHP unless they were pre-approved and deemed medically necessary.

Dental Services Not Covered by the WTCHP

In most cases, the following dental services are not covered by the WTCHP:

• Routine exams, cleanings, and X-rays
• Fillings, crowns, and root canals
• Dentures, bridges, and implants
• Cosmetic procedures such as whitening or veneers
  
  

These services are considered standard dental maintenance and are not linked to 9/11 exposure. WTCHP members seeking routine or cosmetic dental care will need to use private dental insurance, Medicare, or Medicaid benefits, or pay out of pocket for their dental care.

Alternative Dental Care Options for WTCHP Participants

If your dental care is not covered under the WTCHP, there are several options that may help reduce costs or expand access to care:

1. Private or employer-sponsored dental insurance: Review your policy to determine coverage limits and reimbursement rates for major procedures.
2. Medicaid or Medicare: Some states offer limited dental coverage under Medicaid, and Medicare Advantage plans may include dental benefits.
3. Community dental clinics: Many nonprofit or university-based dental clinics offer low-cost or sliding-scale services.
4. Charitable dental programs: Organizations such as Dental Lifeline Network provide free or reduced-cost dental care to those with serious health conditions or financial hardship.

For WTCHP members, it may be worth speaking with your program case manager to determine if any part of your dental needs can be connected to your certified health condition.

How to Apply for WTCHP Benefits and Access Dental Services

If you believe you may qualify for dental services under the WTCHP:

1. Enroll in the WTCHP if you haven’t already. You must provide proof of presence in a 9/11 exposure zone between September 11, 2001, and May 30, 2002.
2. Obtain certification for your 9/11-related condition (for example, oral or neck cancer).
3. Consult your treating physician to determine whether dental services are medically necessary as part of your treatment plan.
4. Contact your Clinical Center of Excellence (CCE) or the Nationwide Provider Network (NPN) for approval before scheduling dental care.

Keep detailed documentation of all medical and dental records, as this will be important if you later file for financial compensation through the 9/11 Victim Compensation Fund (VCF).

How Hansen & Rosasco Can Assist with WTCHP Dental Care Claims

Understanding the WTCHP’s rules about dental care can be complicated, especially when dealing with a serious medical condition like cancer. At Hansen & Rosasco, LLP, our attorneys have decades of experience helping 9/11 responders and survivors navigate both the WTCHP and the VCF.

Our team can help you:

• Determine whether your dental care may qualify for coverage;
• Coordinate with WTCHP case managers and medical providers;
• File and track WTCHP or VCF claims for cancer-related dental procedures; and
• Appeal denied claims or secure compensation for out-of-pocket costs.
  
  

If you have questions about dental coverage under the WTCHP or how to connect it with a 9/11-certified condition, contact Hansen & Rosasco, LLP today for a free consultation. We’re here to ensure you receive the medical and financial support you deserve.