2016 MassHealth Orthodontia Settlement


A group of orthodontist & their patients sued MassHealth for having unduly restrictive medical necessity criteria for approving braces for children & youth under age 21. The case resulted in a settlement changing MassHealth policies. Attached is a copy of a Jan 2016 transmittal letter making changes to the Dental Manual and regulations and the subsequent Aug 2016 settlement agreement. The case was Sam H. v. Patrick when filed & Sam H. v. Baker when settled.