Complaint: AHCCCS wrongly restricted coverage for refugees, immigrants

Health coverage for thousands of refugees and immigrants across Arizona has been wrongly restricted by the state’s Medicaid agency, according to a lawsuit filed this month in U.S. District Court in Tucson.

The Arizona Health Care Cost Containment System, known as AHCCCS, improperly classified immigrants and refugees as only eligible for a limited “emergency” version of AHCCCS, instead of the full AHCCCS benefits for which they qualify, attorneys for the William E. Morris Institute for Justice allege.

The complaint was filed July 22 by the Phoenix-based firm and the D.C.-based National Health Law Program. It says AHCCCS’ misclassifications have harmed the health of plaintiffs with serious conditions — including diabetes, asthma, high blood pressure and depression — that require medication and treatment.

The emergency-only AHCCCS plan covers only conditions that place one’s health in serious jeopardy or cause serious impairment of bodily function or dysfunction of body parts, the suit says.

AHCCCS deputy director Beth Kohler said Thursday that the agency can’t comment on pending litigation.

The complaint lists two Tucson-based plaintiffs, who attorneys say are among thousands with coverage that were wrongly transferred to emergency-only, despite no changes in immigration status. The suit also alleges inadequate notification of the coverage transfers, in violation of the due-process clause of the U.S. Constitution and the federal law establishing Medicaid.

Notification letters sent to immigrants don’t explain what “emergency-only” means, how to file an appeal nor why the agency believes the recipient no longer qualifies.

Not everyone who lost coverage even received notification, said attorney Ellen Katz of the Morris Institute.

Some immigrants don’t qualify for public benefits like AHCCCS and food stamps until they’ve been in the country for five years, but federal law exempts others from the time requirement. Among the exempt immigrants: refugees, those who entered the U.S. before 1996 and victims of domestic violence and extreme cruelty.

The complaint says the five-year requirement appears to have been wrongly applied to many qualified immigrants over the past 18 months.

Katz said her firm first contacted AHCCCS about the situation in October 2015. AHCCCS responded that it had identified 3,500 immigrants whose coverage was wrongly changed and restored their full coverage.

But the problems have persisted since then, Katz said. Some families whose benefits were restored have already been kicked off their AHCCCS plan again, she said.

Last year, AHCCCS said the transfers to emergency-only were due to errors in the new computer system that checks eligibility, the complaint says. The system is used at the Arizona Department of Economic Security, which does the eligibility checks for beneficiaries of AHCCCS and other benefits like food stamps. The mistakes didn’t affect DES’ food stamp eligibility checks, which rely on a different system, the complaint said.

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“We’ve been trying to negotiate this with AHCCCS for nine months,” Katz said. “We have continued to see persons who were improperly transferred, so we know it’s still going on. ... We just feel like at this point, we need to bring the matter in front of a judge.”

The attorneys aren’t trying to prove that AHCCCS is intentionally cutting benefits, Katz said.

“They don’t have to be intentionally doing this” in order to be violating the law, she said.

Tucson plaintiffs

One of the plaintiffs, Tucson resident Aita Darjee, 30, arrived in the U.S. in 2011 as a refugee from Nepal, along with her husband and child, the complaint says. She first discovered her family’s AHCCCS coverage had switched to emergency-only last year. AHCCCS restored the coverage. But this month, the family was again transferred to emergency-only, without explanation or notification.

Her husband, who has diabetes and asthma, discovered the change when his doctor called to cancel an appointment to check his blood sugar, which isn’t covered under emergency-only AHCCCS, the complaint says.

The other plaintiff, Tucson resident Alma Sanchez Haro, 48, came to the U.S. before 1996. She was a victim of domestic violence and is eligible for AHCCCS under the Violence Against Women Act, the complaint says.

She received a “boilerplate” notice in April that she now only had emergency coverage, according to the complaint. During the confusion over her reduced coverage, she had to forgo weeks of medication to treat her depression and anxiety, which led to her becoming suicidal, the complaint says.

Attorneys are asking the judge for certification as a class-action case so that the ruling will cover thousands who have lost full coverage across Arizona.

The complaint seeks reinstatement of full coverage for eligible immigrants, improved notification of benefit changes for plaintiffs, payment of attorneys’ fees and, if the court allows it, reimbursement for out-of-pocket medical expenses the immigrants may have incurred after their health plan was cut.

That likely wouldn’t amount to much money, since most who lost coverage simply had to forgo medical care, Katz said.

“Most of these folks just don’t have money,” she said. “They’re going without.”