AZ Medicaid Copay Hike Class Action Lawsuit

A federal class action lawsuit claims Arizona hiked Medicaid co-pays for single adults and couples without minor children living with them, forcing them to pay copayments that exceed the “nominal” copays authorized by the federal Medicaid Act.

According to the class action lawsuit, the Arizona Health Care Cost Containment System (AHCCCS) amended a rule on October 1, 2003, “with retroactive permission from the U.S. Department of Health and Human Services… 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 childless adults.

The Arizona copayment 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 action lawsuit claims.

Lead Plaintiff Flint Wood claims the “mandatory and heightened copayments” were approved for a second time in 2006 and for a third time in 2011.

The new copays 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 Arizona Medicaid class action lawsuit says.

“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,” the Arizona Medicaid copay rule class action lawsuit states. “As a result of the copayment requirements, Medicaid-eligible persons are not fully participating in the AHCCCS Medicaid program and their health is being adversely affected.”

The class action lawsuit is seeking declaratory and injunctive relief to stop AHCCCS 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 action lawsuit is seeking to represent a proposed class of all Arizona residents who have been or will be charged copayments pursuant to Arizona Administrative Code R9-22-711(F), or who will be deterred from obtaining or denied Medicaid-covered services because they cannot pay the copayments. The heightened and mandatory copayments currently are charged to single adults and couples without minor children living with them, otherwise referred to as “childless adults.”

A copy of the Arizona Medicaid Copay Hike Class Action Lawsuit can be read here.

The case is Flint Wood, et al. v. Thomas Betlach, et al., Case No. 12-cv-08098-DGC, U.S. District Court, District of Arizona.