The state's health care program is illegally denying incontinence briefs to eligible patients who need them, a public interest law firm is charging.
In a lawsuit filed in federal court, an attorney for the Arizona Center for Disability Law charges that the policies of the Arizona Health Care Cost Containment System violate federal laws and regulations that require that programs funded with federal dollars provide all necessary medical supplies to those who are eligible for assistance. Jennifer Nye, who represents several affected individuals, also said the policy runs afoul of laws prohibiting discrimination against those with disabilities.
Nye is asking U.S. District Court Judge John Roll to order AHCCCS to start supplying the briefs. And she seeks reimbursement for patients throughout the state who have had to pay for the items out of their own pockets.
AHCCCS spokeswoman Monica Coury said her agency cannot comment on the specifics of this lawsuit. But she said there would be financial implications if the judge sides with Nye.
"There isn't any money out there to increase services," Coury said. "Our state's budget crisis means that any expansion of a currently covered service would have to be balanced by a reduction somewhere else in the system."
The problem, said Nye, is that AHCCCS will not pay for doctor-ordered briefs for individuals when it's "medically necessary to prevent skin breakdown and infection and to allow integration into the community." Yet Nye said the agency will provide preventative briefs for those who live in nursing homes.
Nye said that means disabled adults who want to be "fully integrated into the community" have to purchase the briefs with their own funds.
"Without the incontinence briefs, plaintiffs with disabilities would be confined to their homes and unable to participate in community, social, education and therapeutic activities, including day treatment programs, which require attendees who are incontinent to wear incontinence briefs," Nye wrote in her legal papers. "Plaintiffs should not have to enter nursing homes or other institutions to receive medical supplies their doctors have determined to be medically necessary."
Nye also is asking Roll to let her represent not only the individuals who are named in the lawsuit but anyone else in Arizona affected by the policy.