ACLU of Indiana Wins Appeal on Cap for Dental Services

Court says individuals can’t be denied medically necessary dental coverage under state’s Medicaid program

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Indianapolis – The State of Indiana cannot violate state and federal Medicaid laws, and people without means in Indiana must receive medically necessary dental treatment, according to a decision today by the U.S. Court of Appeals for the Seventh Circuit.

The Court’s ruling in the class action lawsuit against the Indiana Family and Social Services Administration affirms a lower court decision that granted Sandra Bontrager and others like her a preliminary injunction that prevented the State from enforcing its $1,000 annual cap on dental services.

In 2009, Bontrager’s doctors ordered implant treatments, but those treatments exceeded the state’s cap on such services. Bontrager filed a class action complaint in Elkhart Superior Court in 2011. Her attorney, Jacquelyn Bowie Suess for the American Civil Liberties Union of Indiana, said that even though FSSA had denied Bontrager’s claim, saying the requested services were not “covered dental services,” it was clear the treatments her doctors ordered were both medically necessary and covered under the program.

“The $1,000 cap is often the only reason people without means don’t receive dental treatment ordered by their doctors – care that can well exceed that small subsidy,” said Suess. “Proper health care makes an enormous impact on quality of life. The ACLU of Indiana is thrilled that the Court has ruled in our favor, and that Indiana will be required to abide by state and federal laws in providing dental coverage to those who need it most.”

Jane Henegar, ACLU of Indiana Executive Director, said “The civil liberties guaranteed to each one of us prevents government from unfairly and arbitrarily limiting services. The role of the ACLU of Indiana in this case is to ensure that the State doesn’t shirk its responsibilities under state and federal law by denying health care treatments it has already said it would provide.”

Today’s ruling, Bontrager, et al., v. Indiana Family and Social Services Administration, was entered in the United States Court of Appeals for the Seventh Circuit under cause number 11-3710. Appeal from the United States District Court for the Northern District of Indiana, South Bend Division, cause number 3:11-cv-216 PPS-CAN.