This memorandum provides an annotated listing of Medicaid dental provider participation cases. It does not address the hundreds of cases involving the amount, duration and scope of dental services.
Snapshot of findings:
We located a total of 26 cases, from 21 jurisdictions: Arkansas, California, Connecticut, District of Columbia, Florida, Illinois, Indiana, Kentucky, Maine, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and West Virginia.
The complaints in these cases cite a number of Medicaid Act provisions but focus on the following:
- 42 U.S.C. § 1396a(a)(8) (the “reasonable promptness” requirement that Medicaid to be provided with reasonable promptness)
- 42 U.S.C. § 1396a(a)(30)(A) (the “equal access” requirement that payments to be consistent with efficiency, economy, quality of care and assure equal access)
- 42 U.S.C. §§ 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r) (the “EPSDT” requirement for comprehensive Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for children and youth under age 21) and implementing regulations, e.g. 42 C.F.R. § 441.61(b) (requiring states to “make available a variety of individual and group providers”)
Most cases have settled without a trial. The settlements typically address payment rates and include provisions to address other barriers, such as claims processing, transportation, and lack of awareness among beneficiaries of the availability of dental services through Medicaid. Recently, states have challenged the plaintiffs’ right to enforce the Medicaid Act and/or refused to negotiate, thus requiring the issues to be decided by a trial.
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