JoAnne Morrow, an attorney with Legal Services of Eastern Missouri, has become a champion for local children denied orthodontic treatment by the state’s Medicaid system. In the past 9 years, she has won orthodontic treatment for 89 children in the region who had previously been rejected treatment under the state’s Medicaid standards, according to an article on

Missouri uses the Handicapping Labio-Lingual Deviation (HLD) Index Score Sheet, with a 28-point cutoff, to evaluate orthodontic cases for children younger than 21 who qualify for Medicaid. Local dentists have called in Morrow on their Medicaid cases that were denied because their patients scored lower than the 28-point cutoff.

“The child should get treatment if they qualify, and in almost all of these cases, the orthodontist who examines the child has told me ‘This kid should qualify’,” said Morrow in an interview with She added that the HLD evaluation, which is used in clinical studies and research and never designed for Medicaid eligibility, is flawed.

Morrow relies on the federal Early Periodic Screening, Diagnosis, and Treatment requirement, which says Medicaid treatment is warranted for pain relief or infection and tooh restoration.

“I always emphasize the maintenance of dental health,” she said. That’s what I hang my hat on.”