[Our guest blogger is Clare McGorrian, attorney on the HCFA v. Romney case, who specializes in providing legal services to health care consumers, primarily in health insurance coverage and eligibility disputes.]
Eleven years ago Health Law Advocates and Greater Boston Legal Services filed a class action lawsuit on behalf of MassHealth children who could not find a dentist. Last week, the court successfully ended its jurisdiction over the case (see Globe coverage).
At the trial in October 2004, parents testified to months-long waits to get dental care for their children. MassHealth dental providers corroborated the parents’ testimony. State officials acknowledged that the program received thousands of complaints each month.
In July 2005, U.S. District Court Judge Rya W. Zobel ruled that the MassHealth dental program violated federal Medicaid law. Judge Zobel wrote that the children encountered “extraordinary difficulty” in obtaining timely dental care. She found various barriers to dentists’ participation in MassHealth, including:
- Low reimbursements
- Burdensome claim procedures and slow payments
- Inability to limit the number of MassHealth patients
The judge ordered the Commonwealth to work with Health Care For All to bring the MassHealth children’s dental program into compliance with federal law. The court appointed a neutral monitor, Dr. Catherine Hayes, to facilitate implementation of the necessary changes. The primary directive of the joint remediation plan was to build a network of providers that would provide timely access to dental care for MassHealth children. In keeping with this goal, the improvements to be implemented over five years included:
- Creating and filling the position of MassHealth Dental Director
- Contracting with a dental benefits company to administer the program
- Increasing dental reimbursement rates as needed to improve access
- Developing creative approaches to delivering dental care such as expanding school-based dental services and integrating prevention into pediatric visits
- Amending regulations to eliminate barriers to the receipt of dental care
- Permitting dentists to limit the number of MassHealth patients they treat
Before HCFA won this case, only one third of MassHealth children received a yearly dental visit. Children on MassHealth frequently received emergency treatment for dental pain. After five years of hard work by HCFA/HLA, the state and the monitor, with the active engagement of the court, one half of eligible children now receive an annual dental visit. Participating dental providers have more than doubled. And non-traditional delivery models are receiving increased support, with preventive treatment of children in primary care settings and sustainable funding for the Department of Public Health’s school-based prevention program in the FY 2012 House I budget.
This lawsuit sparked the interest of legislators, providers, the Mass Dental Association, public health dentists, and advocates to come together to ensure that the gains from this lawsuit are not lost, and that both policy makers and the public understand the importance of oral health, as the mouth is the gateway to the body (see our earlier reports from 2006 and 2007). The independent monitor’s Final Report to the Court found that “substantial progress” had been made in all areas: “Both parties have worked collaboratively to achieve these improvements and should be commended for their commitment to ensuring adequate access to dental services for the children in the MassHealth program.”