Callen v. Rogers
In Callen v. Rogers, 216 Ariz. 499, 502, P 9, 168 P.3d 907, 910 (App. 2007), the Court dealt with a request for AHCCCS coverage for "emergency dental care" under another subsection of the same statutory provision, A.R.S. 36-2907(A)(5). 216 Ariz. at 501, P 5, 168 P.3d at 909.
Like coverage for dentures under A.R.S. 36-2907(A)(6), emergency dental care is also an optional service. See 42 C.F.R. 440.225, 440.100 and 440.120.
The plaintiff in Callen argued that "once a state elects to cover any dental service in its plan, it is obligated by the Act Medicaid in its implementing regulations to cover all necessary dental services." 216 Ariz. at 504, P 16, 168 P.3d at 912.
The Court rejected this argument. the Court held that if the Medicaid Act's purpose "was to require each state offering any dental service to provide all necessary dental services . . . it has not done so." Id. at 506, P 25, 168 P.3d at 914.
In reaching this conclusion, the Court stated the principle applicable here: we "examine the purpose of the state's inclusion of the optional service within its plan to ensure that the state's purpose for providing the service is not frustrated" by any "amount, duration, and scope" limitations imposed by the regulation. Id. at 507, P 28, 168 P.3d at 915.
The Courts are in complete accord with the reference to authorities outside Arizona for the proposition that "because dental services are optional under the act, a state was under no obligation to provide them even if necessary, but once it did so without limitations in its coverage statute, the state welfare agency could not impose exclusions by regulation." Id. at 503-04, P 14, 168 P.3d at 911-12.
In Callen, the Court recognized that "courts that have identified state regulations that limit the coverage specified in the state plan have stricken such regulations." Id. at 507, P 28, 168 P.3d at 915.