CHARLESTON, W. Va. (CN) - West Virginia illegally excludes poor children from federally mandated medical services, limiting them to four prescriptions a month and refusing them diagnoses and treatments, a class action claims in Federal Court. The state has given its Medicaid program the cheerful name, "Mountain Health Choices."
Because Mountain Health Choices will cover only four prescriptions a month, it denied covered to plaintiff T.G., who needed "antibiotics and other medications to treat a sinus infection(.) Mountain Health Choices refused to cover his inhaler, which he is required to take twice daily for his asthma," according to the complaint.
"West Virginia Medicaid also refused coverage for a hearing specialist for plaintiff D.W. and would not cover an appropriate certified counselor to treat D.W. for his diagnosed learning disabilities.
"Defendant's coverage decisions are not timely and deny basic due process protections," including written notice and timely opportunities to appeal, the complaint states.
Here is the background:
West Virginia amended its Medicaid law in May 2006, calling it Mountain Health Choices and began enacting it, in three counties, in March 2007. It has continually expanded it since them. Eight-six percent of Mountain Health Choices enrollees are children, and 88% of them are enrolled in the "Basic Plan."
Federal law requires West Virginia's Medicaid plan to cover "Early and Periodic Screening, Diagnostic and Treatment (EPDST) services for Medicaid-eligible children and youth," according to the complaint. "EPDST must include 'necessary health care, diagnostic services, treatment, and other measures ... to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services ... Among the required treatment services are prescription drugs, rehabilitation services, personal care services, and therapy services, when needed to correct or ameliorate a child's condition."
But West Virginia's Mountain Health Choices "Illegally and arbitrarily places exclusions and quantitative limits on health services for Medicaid-eligible children in West Virginia. The plaintiffs' needs exceed those limits," the complaint states.
The class wants West Virginia's Mountain Health Choices enjoined as unconstitutional and in violation of Medicaid and Social Security law.
The class' lead counsel is Bren Pomponio with Mountain State Justice.
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