State can’t impose a cap on Medicaid services for dental treatments

Thousands of Hoosiers without means whose doctors ordered medically necessary dental treatments that exceeded a state-imposed cap on Medicaid services received relief from a federal appeals court ruling in 2012.

The ACLU of Indiana brought a class-action lawsuit, Bontrager, et al., v. Indiana Family and Social Services Administration, on behalf of an Elkhart, Indiana woman, Sandra Bontrager, and others. In 2009, Bontrager's doctors ordered dental implant treatments, which were medically necessary and covered by Medicaid, but FSSA denied her claim, saying the requested services exceeded an imposed $1,000 cap.

The State cannot deny health care treatments it already had said it would provide, and cannot unfairly and arbitrarily limit these services in violation of state and federal Medicaid laws.

Proper health care makes an enormous impact on our quality of life. The $1,000 cap on medically necessary dental services was often the only reason people without means did not receive treatments ordered by their doctors, care that can well exceed that small subsidy, such as implants or dentures.

In its 2012 decision, the appeals court recognized the State's potential budgetary concerns, but said those concerns did not "outweigh the potential harm" to indigent individuals. The Supreme Court of the United States declined to hear the case, and Indiana will be required to abide by state and federal laws in providing dental coverage to those who need it most.

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