Opinion ID: 2311632
Heading Depth: 1
Heading Rank: 1

Heading: The Child's Need For Orthodontia

Text: The Commissioner, after reviewing the fair hearing record, found that Applicant is in need of orthodontia. Now, on appeal, defendant urges us that this statement should not be construed as a finding that the child's dental condition is of such a serious nature as to meet federal standards for entitlement to treatment ( even if orthodontia is an available treatment  an issue to be discussed later). At this point it will be sufficient to say that the federal regulations commit the Medicaid program to restoration of teeth and maintenance of dental health (45 C. F.R. § 249.10(a) (3) (iv)), to correct or ameliorate . . . abnormalities (MAM 5-70-20(A)(3)) and to treat dental problems which, if untreated, may become acute dental problems or may cause irreversible damage to the teeth or supporting structures. MAM, 5-70-20(G)(1). The Commissioner was aware that both Dr. Marcotte and Dr. Garcelon had approved of the application for the child's orthodontia and that the Medical Claims Consultant (whom he apparently referred to as the Medical Services Specialist) had found that her need had been substantiated. He had before him the record of the fair hearing with the reports from the child's dental experts and the undisputed evidence of her serious dental defects and he had read there her attorney's insistence that the question of her medical eligibility was an issue which should be fully presented at that hearing. No evidence disputing this need was presented. It is inconceivable that the Commissioner intended his finding of her need of orthodontia to mean anything less than that her problem threatens her dental health. If he had not meant that she was medically eligible, there would have been no need for him to have gone further with the other issue.