PRESCOTT, Ariz. (CN) – Arizona is forcing single adults and couples without minor children living with them to pay copayments that exceed the “nominal” co-pays authorized by the federal Medicaid Act, according to a federal class action.
On Oct. 1, 2003, the Arizona Health Care Cost Containment System (AHCCCS), “with retroactive permission from the U.S. Department of Health and Human Services, implemented an amended rule that required certain Medicaid-eligible Arizonans to pay copayments that exceed the limited, ‘nominal’ copayments authorized by the federal Medicaid Act” if the participants are single adults and couples who do not have a minor child living with them, according to the complaint.
The rule “also allowed health care providers to deny care and services to Medicaid beneficiaries who are unable to pay the copayment, in violation of the federal Medicaid Act,” the class claims.
Lead plaintiff Flint Wood claims the “mandatory and heightened copayments” were approved for a second time in 2006 and for a third time on Oct. 21, 2011.
As “a result of the copayment requirements, eligible AHCCCS participants, including persons with significant medical conditions, for example, persons with deformities of the back and spine, asthma, and major depression do not have the money to pay for their copayments and are going without needed medical care,” and “Medicaid-eligible persons are not fully participating in the AHCCCS Medicaid program and their health is being adversely affected,” the class claims.
The co-pays include $4 for each generic prescription, $10 for a brand name prescription, and $5 for an office visit. Before the rule was imposed in 2003, an office visit cost $1, the class says.
Wood, who suffered an ATV accident in 1999 that caused bleeding in his brain and a spinal fracture, says AHCCCS wants him to pay more than $60 per month for his medical care, though some weeks he earns only $20, collecting aluminum cans and scrap metal to sell.
Wood says he “often cannot afford his medications and has to go days and sometimes weeks without some of his medications.”
The plaintiffs seek declaratory and injunctive relief to stop Arizona Health Care Cost Containment System Director Thomas Betlach and U.S. Secretary of Health and Human Services Kathleen Sebelius “from continuing to violate the Medicaid provisions of the Social Security Act, which strictly limit the imposition of ‘copayments’ on AHCCCS participants.”
The class is represented by Ellen Katz of the William E. Morris Institute for Justice in Phoenix, and Jane Perkins of the National Health Law Program of Carrboro, N.C.