Thousands of low-income Arizonans are being denied government health care or charged too much for it because the state’s Medicaid program has instituted new and increased copays that violate federal law, a lawsuit alleges.

The Arizona Health Care Cost Containment System instituted the new and increased copays for approximately 100,000 of its enrollees in October, following a legislative mandate to implement “cost-sharing’’ steps intended to help balance the current state budget.

The class-action lawsuit filed on behalf of 13 individuals alleges that the copays exceed federal limits, which allow only “nominal’’ amounts. Also, providers are denying care and prescriptions to people unable to pay the copays and the notices sent AHCCCS recipients violate their due-process rights, the lawsuit contends.

While some AHCCCS enrollees have received drug samples and free care from providers when the enrollees couldn’t afford to pay copays, others have been turned away or been forced to use money they need for food or housing, the lawsuit contends.

Copayments, or copays, are fees people must pay under certain health plans for visits to doctors, care in hospital emergency rooms and prescription drugs.

Copayments Apply To 100,000 Of 960,000 Enrollees

The new or increased copays required by AHCCCS include $4 for a generic prescription, $10 for a brand-name prescription, $5 for an office visit and $30 for the non-emergency use of an emergency room.

Previous AHCCCS copays included $1 for an office visit and $5 for non-emergency use of an emergency room.

AHCCCS received permission from the federal Department of Health and Human Services in June to implement the copayments, according to the lawsuit filed Dec. 17 in U.S. District Court.

AHCCCS spokesman Frank Lopez said the lawsuit was under review and that he did not know how the state would respond.

Mr. Lopez said the copayments apply only to approximately 100,000 AHCCCS recipients — out of AHCCCS’s total 960,000 enrollees — who mostly are eligible because of an expansion approved by voters as Proposition 204 on the November 2004 ballot.

The federal government would not permit new or higher copays for traditional Medicaid recipients enrolled in AHCCCS, Mr. Lopez said.

Mr. Lopez said there were implementation “questions and concerns” from providers when the copays were instituted but that AHCCCS enrollees received notices in the mail.

Representatives of the Department of Health and Human Services and its Centers for Medicare & Medicaid Services did not answer calls Dec. 26. Defendants include AHCCCS Director Tony Rodgers, HHS Secretary Tommy Thompson and their respective agencies.

AHCCCS officials told lawmakers in September that they had not implemented some cost-sharing steps for fear that doing so would run afoul of federal requirements and drive away some would-be enrollees.

However, Mr. Rodgers assured lawmakers that AHCCCS was not trying to evade implementation of required fees and considered them a mandate.

The chairman of the House Appropriations Committee said at the time that charging the new or higher fees could get AHCCCS enrollees to think twice about getting care they might not need.

The lawsuit was filed on behalf of the 13 individuals by the William E. Morris Institute for Justice, the Arizona Center for Disability Law and the National Health Law Program.

FYI

The 13 individuals named as plaintiffs: Sharon Newton-Nations, 59, Anthem; Manuela Gonzalez, 58, Tucson; Cheryl Bilbrey, 54, Casa Grande; Donald McCants, 56, Phoenix; Hector Martinez, 57, Tucson; Anne Garrison, 62, Phoenix; Dawn House, 23, Glendale; Dana Franklin, 55, Surprise, Edward Bonner, 60, Phoenix; Jack Baumhardt, 60, Phoenix; Manuel Esparza, 52, Tucson; Patricia Jones, 63, Yuma and a man identified only as D.H., 33, Phoenix.

The court filing number is CV 03-2506 PHX EHC. —