Opinion ID: 415223
Heading Depth: 1
Heading Rank: 1

Heading: The EPSDT Program and the 1979 Cutback

Text: 3 For several years, Texas has operated an EPSDT program in cooperation with the federal government. Prior to 1979, EPSDT-eligible children could obtain annual dental checkups. At these checkups, the child's teeth were examined by the treating dentist--visually and/or through use of X-ray equipment. The EPSDT child could receive a fluoride treatment and the dentist was authorized to select any of several dental services should the particular circumstances of the child's dental condition warrant use of such services. These available dental services included: (1) topical fluoride; 1 (2) posterior root canals; 2 (3) fixed space maintainers; 3 (4) partial dental appliances on the posterior teeth; 4 (5) porcelain crowns; 5 (6) antibiotic injections; (7) frenulectomies; 6 and (8) nonsymptomatic extraction of impacted teeth. 4 In 1979, the Texas Legislature cut the amount of funds the State of Texas would invest in the EPSDT program by forty-five percent. The Texas Department of Human Resources (TDHR) was responsible for allocating the reduced funds and significant cutbacks in available EPSDT services naturally followed. TDHR lengthened the period of time between preventive dental checkups from one year to three years. During this three-year period, the EPSDT child could receive dental services only if the particular dental condition fell within one of three limited exceptions: (1) the emergency exception; (2) the obvious need exception; or (3) the medical necessity exception. An emergency situation exists when an eligible child experiences pain, infection, or swelling in the oral cavity. Record, vol. 6 at 63 (Testimony of Cecil Chandler, Senior Dental Consultant, TDHR). An obvious need situation exists when the recipient, a parent, a teacher, or any other interested person actually observes a clear dental problem. Id. at 67. Finally, a situation of medical necessity exists when a recipient has a dental problem that will adversely affect the child's overall health unless immediately treated. Id. at 63. TDHR also removed several previously available dental services from the EPSDT program, namely: (1) topical fluoride; (2) posterior root canals; (3) fixed space maintainers; (4) partial dental appliances on posterior teeth; (5) porcelain crowns; (6) antibiotic injections; (7) frenulectomies; and (8) nonsymptomatic extraction of impacted teeth. 5 TDHR's proposed changes in the EPSDT program were proposed for permanent adoption by publication in the Texas Register on September 21, 1979. See Volume 4 Tex.Reg. 3385 (Sept. 21, 1979). However, the elimination of the eight aforementioned dental services actually occurred in May and July of 1979 and the triennial access schedule went into effect on September 1, 1979. Clearly, no prior actual notice of the cutbacks was provided to eligible recipients. Record, vol. 3 at 458. 6 In summary, whereas the pre-1979 EPSDT program provided eligible children with annual preventive and restorative dental checkups and several available basic dental procedures to maintain eligible children's dental health, the post-1979 EPSDT program provides eligible children with triennial preventive checkups and allows the treating dentist to treat a detected dental problem arising in between the three-year visits only if it falls within the limited exceptions of emergency, obvious need, or medical necessity. Moreover, eight basic dental services available under the 1979 program are no longer available to the treating dentists under the post-1979 EPSDT program.