Medical Necessity

April 18, 2013


ACS CAN and ACS Great West Division partnered with Support for People with Oral, Head and Neck Cancer (SPOHNC) in July 2009 to file an friend of the court brief at the Arizona Supreme Court in support of access to care for cancer survivors who suffer major dental damage as a result of their cancer treatments. The issue is whether Arizona Health Care Cost Containment System Administration (AHCCCS), which administers the Arizona Medicaid program, should be required to cover dental costs as "medically necessary." There are many cancer survivors who suffer extreme damage to their teeth, gums and jaw as a result of their cancer treatments. AHCCCS has denied payment for dental costs of these cancer survivors, claiming the treatment is not necessary because the survivors could live on a liquid diet for the rest of their lives. Our brief argued that AHCCCS should pay for dental care if the need is a result of predictable and severe damage from a patient's fight to survive cancer. Unfortunately, the legislature subsequently passed a law saying that Medicaid will not cover any dental expenses in Arizona.