Health Law Advocates, Inc.
30 Winter Street, Suite 1004
Boston, MA 02108
Poor oral health can lead to other significant health problems, including increased severity of cardiovascular disease and diabetes, complications of immune disorders and cancers, and increased incidence of premature and low-birth-weight babies. On a day-to-day basis, the pain caused by tooth decay can interfere with eating, speaking, learning, and working.
Improving access to oral health care for children and adults who lack dental insurance or who have insurance that does not adequately cover needed care has been a longtime priority for HLA. HLA’s Dental Health Access Project has included landmark class-action litigation that improved oral health care for hundreds of thousands of children living in low-income households as well as legal advocacy on behalf of individuals without access to dental services and public policy advocacy to improve public dental insurance.
The DentaQuest Foundation provides generous support for HLA’s Dental Health Access Project.
In February of 2011, HLA concluded a highly successful decade-long effort to improve access to dental care for Massachusetts children in low-income families. As a result of our efforts, hundreds of thousands of children are receiving better dental care than they did ten years ago.
In 2000, HLA initiated litigation against the Commonwealth of Massachusetts on behalf of the hundreds of thousands of children in the MassHealth program because the program was providing these children with substandard access to dental services. After five years of litigation in federal court, HLA won the lawsuit, Health Care For All v. Romney, when federal district court judge Rya Zobel ruled in HLA’s favor in determining that the MassHealth dental program for children was so poor it violated federal law. Judge Zobel ordered HLA, the Commonwealth and a court-appointed independent monitor to begin a five year remediation process in 2006 to collectively work to improve dental services for children enrolled in MassHealth.
Between February of 2006 and February of 2011, HLA attorneys worked under court supervision to make dramatic improvements in the MassHealth pediatric dental program. We successfully urged the Commonwealth to hire a third party administrator to run the program and to create the position of Dental Director within MassHealth. We collaborated with the Commonwealth and the court monitor to fashion new policies to attract new dentists to the MassHealth program by providing better reimbursement rates and the ability to limit caseloads. We also were successful in advocating for the creation of new care delivery programs in the schools and elsewhere outside the traditional dental office.
By the end of the court-ordered remediation program in February 2011, HLA had achieved extraordinary increases in access to dental care for low-income children. In fiscal year 2010, 56% of children with MassHealth received a dental exam compared to 39% percent in fiscal year 2006. This significant gain was achieved even though 130,500 more children were enrolled in MassHealth in FY 2010 than in FY 2006. In addition, in FY 2010, there were 3,082,155 claims submitted by dental providers to MassHealth compared to 1,920,951 in FY 2006. This means that more than 1 million more dental services were provided to children as a result of our lawsuit.