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HHS Sued for Allowing California to Limit Access to Dental Care for Older Patients and Patients with Disabilities

Reprint from AARP Pressroom HALTH CAREGIVING & LONG TERM CARE

JAN 21, 2021

LOS ANGELES—Registered Dental Hygienists in Alternative Practice (RDHAP), a group of dental hygienists represented by AARP Foundation and Foley & Lardner LLP, are suing the U.S. Department of Health and Human Services (HHS) for its approval of changes to California’s Medicaid Plan that effectively eliminate access to critical dental care by California’s elderly and Medicaid beneficiaries with disabilities.

The lawsuit filed by RDHAP alleges that California’s new preauthorization process and 58% rate cut to periodontal maintenance (a treatment for gum disease) often leave California’s institutionalized Medi-Cal recipients without critical dental care. In 2018, HHS, through CMS, approved a rate cut for perio-maintenance from $130 to $55. HHS also approved a new preauthorization process for scaling and root planning that required new diagnostic x-rays.

Plaintiff Diane Brown, one of the RDHAPs who treats severely disabled patients says that, “Most of my patients in Intermediate Care Facilities are unable to take X-rays due to medical conditions; they cannot keep their head still or bite down sufficiently to take x-rays.”

“California has cut the pay of Medicaid providers to treat periodontal disease in nursing homes by more than 50%, resulting in a denial of access to oral health care for California’s most vulnerable citizens,” said AARP Foundation Senior Vice President for Litigation William Alvarado Rivera. “When older adults experience a decline in oral health due to pain and tooth loss, they are unable to chew their food, which also leads to a rapid decline in their nutritional status and overall health. Without treatment, these patients have difficulty not only eating, but also speaking, and suffer increased isolation.”

The lawsuit alleges that HHS’s arbitrary approval of unwarranted and onerous procedural hurdles to their provision of periodontal care to patients and the devastating 58% rate cut “has resulted in a complete denial of periodontal maintenance to thousands of Medi-Cal beneficiaries who reside in skilled nursing and intermediate care facilities.”

California residents who have struggled to get the perio-maintenance services they need can contact AARP Foundation at litigation@aarp.org.  

Please find the complaint here.

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