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Federal court throws out adult Medicaid cap

Decision affirms longstanding IDA position


An Indiana federal judge has ruled on a class action lawsuit that the state must fully cover dental services that are medically necessary for Medicaid participants.

The decision affirms the Indiana Dental Association’s position that a $1,000 cap on Medicaid is a hindrance to Medicaid patients seeking dental care. The IDA testified at multiple rules hearings last year to stress the importance of removing the cap.

As of November 5, 2011, HP, the state reimbursement agent, is informing participating dental offices that the $1,000 cap has been lifted, but that all other service and benefit restrictions remain in place.

The IDA is currently working with the Indiana Family and Social Services Administration to determine what the adult dental Medicaid benefit will be, as well as how the term, “medically necessary,” will be interpreted. 

“A bulletin from the Office of Medicaid Policy and Planning announcing the policy change is expected either this week or next,” stated Ed Popcheff, IDA Director of Governmental Affairs.

State fiscal realities remain the same. The IDA is currently studying the policy implications of the case and is viewing it as an opportunity to further refine the state’s dental Medicaid Policy.

Additional information may be found at anytime on the official Indiana Medicaid website,

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Ed Popcheff, Director of Governmental Affairs

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