In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on Medicaid coverage for medically necessary dental services, and concluded the cap most likely violated rights granted to Medicaid beneficiaries under federal law. Bontrager v. Indiana Family and Social Services Administration, 2012 U.S. App. LEXIS 20157 (September 26, 2012).
Under federal Medicaid law, coverage of “dental services” (like prescription drug coverage) is optional. Indiana elected to cover certain dental services that are medically reasonable and necessary and not listed as non-covered or otherwise excluded. However, the state imposed a $1,000 per recipient annual limit on such services. Plaintiffs brought suit under 42 U.S.C. § 1983, alleging that the cap violated federal and state law because it prevented Medicaid beneficiaries from receiving medically necessary services above the cap.
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