Suit Filed Against State on Behalf of 400,000 Michigan Medicaid-Dependents
Denied Access to Dental Healthcare
Class action lawsuit seeks to rectify State's refusal to fund essential dental
care for developmentally disabled and financially limited individuals. The
State is in violation of requirements under federal Social Security Act's
Medicaid provisions, jeopardizing the health of hundreds of thousands of
vulnerable Michigan Medicaid beneficiaries.
LANSING, Mich., Oct. 29 /PRNewswire/ -- In a move aimed at forcing the State
of Michigan and the Legislature to protect the rights of Michigan's most
vulnerable population, including the developmentally disabled and those with
minimal financial resources, a lawsuit was filed in federal court against the
Granholm Administration. A class of more than 400,000 at-risk Michigan
residents is suing the State for failing to uphold its legal obligations with
regard to funding certain dental care services under the federal Medicaid
program.
The suit seeks to compel the State to bring its funding scheme for adult
dental benefits under Michigan's Medicaid program back into compliance with
federal law.
Speaking on behalf of the class, Dykema attorney Gary Gordon of Lansing, said
the suit became necessary after the Granholm Administration's May Executive
Order, effective July 1st, 2009, virtually eliminated Medicaid adult dental
benefits. Michigan's Legislature's failed to restore funding for the program
for the balance of the 2009 fiscal year; and the Legislature and Governor have
neglected to make any changes to the funding scheme established by the
Executive Order in the proposed 2010 budget.
"Unfortunately, the State has left no alternatives to this group of
disadvantaged citizens but to take the State to court to ensure their that
federally-protected rights to a certain minimum level of medical services are
protected," said Gordon. "The State holds a legal, moral and fiduciary
obligation to these citizens and to the taxpayers."
Although participation in the federal Medicaid program is optional, once a
state 'opts in,' and thereby obtains federal funding, the State must comply
with all federal requirements. The suit alleges that, by effectively
eliminating adult dental benefits, Michigan is violating key federal
regulatory and statutory mandates, including:
-- Failing to adopt and maintain programs and policies that operate to
make
dental care available for Medicaid beneficiaries throughout Michigan;
-- Failing to provide proper and efficient operation of the Medical
Assistance Program, and to provide payments that facilitate provision
of
care in a manner consistent with the best interest of Medicaid
beneficiaries;
-- Failing to provide payments that facilitate adequate participation by
Michigan dental providers in the Medical Assistance Program, resulting
in some Medicaid beneficiaries in Michigan being able to obtain
sufficient dental care while others cannot;
-- Acting in an arbitrary and capricious manner, and contrary to and in
violation of the efficiency, economy, and quality of care provisions;
and
-- Failing to enlist enough providers so that dental health care and
services are available to Medicaid-eligible adults who reside in
various
geographic areas in Michigan, including, without limitation, numerous
counties in the northern portion of the lower peninsula, at least to
the
extent that such care and services are available to the general
population.
Michigan elected to participate in the federal Medicaid program in October
2005. As such, Michigan is legally bound to provide funding for services and
benefits in compliance with all of the requirements in federal law. To
discontinue participation, Michigan must provide official notice to the
federal government of its change in policy; to date, the State has not done
so, and is therefore obligated to fulfill its obligations under the Medicaid
program.
Declaring that the move to alter the funding scheme for the Medicaid dental
program was intended to address Michigan's fiscal solvency challenges, the
governor effectively aggravated the State's budget woes. By dropping the
State's fiscal commitment of less than $5 million in the State Medicaid budget
of more than $8 billion, Granholm has caused Michigan to forego some $16
million in federal matching money that Michigan receives annually to fully
fund Michigan's Medicaid dental program.
Not only is the State worsening its fiscal situation by leaving available
federal money off the table, it will bear the burden of steeper Emergency Room
costs, the result of those forced to access care through more expensive
hospital providers. What's more, elimination of the changes to the adult
dental benefit in the State's Medicaid program could make thousands of
Michigan residents with marginal resources more vulnerable to debilitating and
potentially life-threatening illnesses.
Adequate dental care is vital to overall general health. Regular dental care
and treatment can prevent such catastrophic illnesses as diabetes, heart
disease, arteriosclerosis, and cancer; and regular dental care is often
critical in the early detection and successful treatment of these diseases.
Untreated dental disease in pregnant women can cause pre-term delivery or low
birth-weight babies.
The suit was filed Wednesday in the United States District Court for the
Western District of Michigan, located in Grand Rapids. The case is assigned
to Judge Robert Holmes Bell.
SOURCE Dykema
Deborah Muchmore, for Dykema, +1-517-372-4400; debm@mrgmi.com; Gary P. Gordon,
Dykema, +1-517-374-9133; ggordon@dykema.com
