Bontrager v. Ind. Family and Social Services Administration

Federal 7th Circuit Court
Civil Court
Case Number: 
No. 11-3710
Decision Date: 
September 26, 2012
Federal District: 
N.D. Ind., S. Bend Div.
Dist. Ct. did not err in granting plaintiff's request for preliminary injunction in class action that challenged Indiana's $1,000 annual limit for dental services covered by Medicaid, after finding that defendant was required to cover all medically necessary dental services irrespective of instant monetary cap. Plaintiff possessed private right of action to challenge instant cap and further demonstrated likelihood of success where: (1) State was required to provide Medicaid coverage for medically necessary treatments in those service areas, such as dental care, that State opted to provide coverage; and (2) instant $1,000 cap could not be viewed as valid "utilization control procedure" where cap was not based on degree or consideration of medical necessity, and where said cap completely excluded from services certain medically necessary dental services. Record further showed that plaintiff would suffer irreparable harm if injunction were not granted.