State sued over AHCCCS copayments

PHOENIX -- A public interest law firm is suing the state over what it says are illegal copayment requirements of some health care recipients.

The lawsuit filed in U.S. District Court says the new fees being imposed by the Arizona Health Care Cost Containment System on childless adults are not permitted under federal Medicaid law. AHCCCS is the state's Medicaid program, with the federal government picking up a majority of the cost.

Attorney Ellen Katz of the William E. Morris Institute for Justice, acknowledged that the increase in fees was approved by the U.S. Department of Health and Human Services. But Katz, said that action by HHS Secretary Kathleen Sebelius was improper.

Prior to 2003, AHCCCS charged copays of $1 per visit to a doctor's office, $5 for nonemergency surgery and the same for nonemergency use of the hospital emergency room.

AHCCCS sought that year to implement a new charge of $4 per prescription of a generic drug and $10 for a brand name when a generic is available. The agency also sought to raise the cost of a visit to the doctor's office to $5, with a $30 charge for nonessential emergency room care.

A court blocked the move at that time. But Katz said that did not keep the state from reinstituting the fees in 2010 as part of a cost-cutting measure, a move Sebelius approved.

Katz said individuals on whose behalf her organization has sued have had to go without their prescription drugs and visits to the doctor because they lacked the money for the copys.

"Two of the plaintiffs ended up in the emergency room because they could not get needed medical care,'' she said.

There was no immediate response to the lawsuit by AHCCCS officials.

AHCCCS generally provides free care to anyone below the federal poverty level.

Until 2010 that also included childless adults. But the agency, in a cost-cutting move, stopped enrolling people in this category, though those already in the program, estimated by Katz at more than 120,000, continue to get care, albeit with the higher copays.

Courts have so far refused to force the state to once again provide care for all childless adults who meet the income limits. No date has been set for a hearing on this new action.