Background:

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a prevalent congenital anomaly worldwide, posing significant health challenges. Despite its impact, the U.S. lacks a unified approach to CL/P care coverage, resulting in disparities in access and quality of care. This paper conducts a literature review utilizing PubMed and legal databases to analyze existing medical-legal frameworks, focusing on the Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act (HIPAA), and state-level mandates. Disparities in coverage and access across states are highlighted, with a detailed case study examining state policies in Massachusetts, Illinois, and Indiana. 

Methods:

To comprehensively explore the landscape of CL/P care coverage in the United States, a thorough medical and legal literature review was conducted. PubMed and Google Scholar were utilized to identify the relevant medical articles, research papers, and scholarly publications. Use of the Lexis and Westlaw databases allowed for the identification of the regulatory frameworks governing CL/P coverage in the United States, including Massachusetts, Illinois, and Indiana’s policies. 

Results:

The analysis reveals significant variations in coverage and access to care for individuals with cleft lip and palate (CL/P) across different states in the United States. While some states, like Massachusetts, have developed detailed and comprehensive policies addressing various aspects of CL/P treatment, others, such as Illinois and Indiana, exhibit limitations that may leave gaps in care access beyond infancy. Disparities in coverage are evident, with implications for patient outcomes and healthcare equity. Additionally, existing federal legislation, such as the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA), falls short in providing specific mandates for CL/P care, contributing to inconsistencies in coverage and access at the national level.

Conclusion: 

The findings underscore the need for healthcare reform to ensure equitable access to CL/P care across the United States. Such a reform should encompass all necessary services prescribed by healthcare providers to optimize patient outcomes.