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Florida dental groups support Medicaid lawsuit

Miami—Children's access to dental care and Medicaid reimbursement issues went to trial Dec. 7 in U.S. District Court here.

The Florida Academy of Pediatric Dentists, with Florida Dental Association support, the Florida Pediatric Society and a group of parents/guardians on behalf of their children sued the state over Medicaid issues dividing the federal judiciary and attracting media attention, issues at play as well in the national health care reform debate.

The dental associations allege that Florida has failed to provide essential medical and dental services for children enrolled in or eligible for Medicaid. There are insufficient dentists and medical providers to assure access to care because, among other factors, the state reimbursement level is so low, plaintiffs assert.

An Associated Press report on the suit cites recent American Dental Association testimony about the "significant effect" increased reimbursement rates can have in improving children's access to health care. "Medicaid's dental programs that reimburse at market-based rates will succeed in meeting children's oral health needs," said testimony submitted to the U.S. House of Representatives by the ADA and American Academy of Pediatric Dentistry (ADA News Today Oct. 21, ADA, AAPD support dental Medicaid public-private partnerships).

"This case applies not just to the dozen or so named plaintiffs, but also to the approximately 1.6 million children currently covered by Florida Medicaid during the course of a year," says a summary at the state association Web site.

The state has argued it is obligated only to reimburse doctors with reasonable promptness and is not responsible for whether the Medicaid population actually receives the services required under the law, said a Florida Dental Association spokeswoman.

Among legal issues dividing the federal judiciary are these, she said:

  • Whether plaintiffs have a private right of action to sue under the Medicaid statutes; do the statutes allow providers of health care services, in contrast to patients receiving services, to sue the Medicaid program;
  • Whether the term "medical assistance," as used in the statutes, obligates the state only to pay for medical care or makes the state responsible for actually providing the care.

"No matter how the trial court rules, the case is likely to see appellate review because the law is split among the circuits on these two legal issues," the FDA spokeswoman said. "In the meantime, Florida faces serious financial problems and continues pilot programs to evaluate whether managed care expansion is the answer to the challenges faced by its Medicaid program."