Dental

MassHealth has started posting fair hearing decisions on its website. As of February 2024, there are over 2400 decisions from July -Sept 2023 currently posted with a filtering feature by topic. 

For general information on dental services in MassHealth, CMSP and the Health Safety Net, visit this MassHealth website https://www.mass.gov/info-details/learn-about-masshealth-dental-benefits For legal advocates the starting point is in the MassHealth Dental Regulations, they are…

Dayanne v. Baker, Middlesex Superior Court, No. 2081CV01893 (J. Camille Sarrouf Jr., Order of Dec. 14, 2020) This was a case brought by an organization of orthodontists and 5 children denied orthontic treatment by MassHealth.  On Dec 14, 2020 the Court entered a preliminary injunction…

Favorable BOH decision reversing Dentaquest denial of prior authorization for deep gum and root cleaning. Dentaquest is the third party administrator of the MassHealth dental program. The decision concerns periodontal care for an adult.  Note that on the last page the hearing officer writes:…

A group of orthodontist & their patients sued MassHealth for having unduly restrictive medical necessity criteria for approving braces for children & youth under age 21. The case resulted in a settlement changing MassHealth policies. Attached is a copy of a Jan 2016 transmittal letter making…

Judge Zobel's Feb 3, 2006 order on the relief for children & youth under age 21 denied access to adequate dental care in MassHealth. See the July 14, 2005 decision on the merits. Congratulations to HLA, GBLS & colleagues.

Parties' briefs for summary judgment in dental case. State claims no private cause of action to enforce Medicaid Act. Argued 07/12/2004. On Oct 2, 2004 J. Zobel made her decision on 5 counts under the Medicaid Act 42 USC 1396a. For each count the issue was whether Congress intended used…