Callen v. Rogers – 10/18/2007

October 23, 2007

Arizona Court Of Appeals Division One Holds That AHCCCS is Permitted by the Federal Medicaid Program to Provide Coverage Only For Emergency Dental Services.

Under the federal Medicaid program, the federal government provides matching funds to partially pay for state programs that provide medical assistance to qualifying recipients. Arizona Health Care Cost Containment System (“AHCCCS”) is Arizona’s Medicaid program. Callen sought approval from AHCCCS for a surgical procedure to extract all of her remaining teeth. The AHCCCS Director approved coverage for the extraction of some, but not all of Callen’s teeth, based on testimony from its dental consultant that while removal of all of Callen’s teeth was medically necessary, only eight of the teeth required “emergency” extraction. Because AHCCCS only provides coverage for emergency dental services, the Director denied coverage for the remaining extractions. The superior court affirmed, and Callen timely appealed.

On appeal, Callen argued that pursuant to Medicaid, once Arizona decides to provide some dental coverage under AHCCCS, it is required to provide all necessary dental care to qualified recipients. The Arizona Appeals Court disagreed. The Court explained that Medicaid mandated that participating states provide coverage for certain categories of medical assistance, but designated other categories as “optional.” For those optional services, such as dental care, states are given substantial discretion to select the level of coverage, if any, they wish to provide, and to limit that coverage according to the state’s financial ability to provide such coverage and the degree of need of the recipient. This is in accordance with a primary purpose of the Medicaid program, to provide flexibility and discretion to states to choose the mix of services if offers its eligible population. Thus, Arizona is free, under Medicaid, to provide optional dental services only to those who have an emergency need for them.

Judge Snow authored the opinion; Judges Winthrop and Portley joined.