A class action lawsuit has been filed against the Arizona Health Care Cost Containment System on behalf of children with disabilities that leave them incontinent.

The suit, filed June 21 in federal court in Tucson by the Arizona Center for Disability Law, seeks to have AHCCCS cover the cost of briefs for children with that disability who are receiving Medicaid benefits.

Sally Hart, senior litigation attorney with the center, said AHCCCS has a policy of covering incontinence supplies when necessary for treatment for open sores.

“Arizona’s policy to wait until a child with a disability develops skin breakdown and infection before covering incontinence briefs is cruel as well as contrary to federal Medicaid law,” Ms. Hart said. “It is well recognized by Medicaid programs across the United States that incontinence briefs for children are medically necessary and must be provided.”

Frank Lopez, AHCCCS public information officer, confirmed that the AHCCCS policy is to not cover incontinence briefs unless the children experiences sores or infection.

“The program is guided by medical necessity,” Mr. Lopez said. “We treat a medical condition, but we do stress preventative care for our members.”

Ms. Hart said 36 states now cover incontinence briefs under their Medicaid programs. “It’s time for Arizona,” she said.

Mr. Lopez explained: “The feds give the states a lot of discretion. This state made the decision to allocate its resources differently.”

Mr. Lopez said AHCCCS is amenable to considering policy changes, and said depending on the scope of the problem, the annual cost to AHCCCS could be in the millions of dollars.

He declined to comment further until the agency receives a copy of the suit.

Ms. Hart said: “A component of Medicaid — early periodic screening diagnosis and treatment — requires an expanded package of health services for children to enhance their development and to enable them to function. We believe it requires coverage of incontinence.”

Medical conditions that can lead to incontinence include Down Syndrome, mental retardation and cerebral palsy, Ms. Hart said.

“It’s not for a lack of toilet training,” she said. “Incontinence supplies keep the moisture away from the skin to prevent sores. It enables them to function under adverse conditions.”

Governor’s Council Backs Suit

Several organizations expressed support of the lawsuit against AHCCCS, including the Epilepsy Foundation of Arizona and the Governor’s Council on Developmental Disabilities.

Jami Snyder, director of the Governor’s Council, was asked about the council’s support of a lawsuit against a state agency that is under the purview of the governor.

“We are 100 percent federally funded and we act fairly independently,” Ms. Snyder said. “Part of the federal mandate is to inform and educate policymakers on policy issues that may impact people with disabilities. We believe the AHCCCS policy has a detrimental impact on those individuals. We see this as part of our role.”

Although members of the council are appointed by the governor, Ms. Snyder was hired by the council.

Ms. Hart said she doesn’t know how many children are affected by the current AHCCCS policy.

Peri Jude Radecic, director of public advocacy for the center, said the cost of incontinence briefs depends on the size and weight of the child. Generally monthly costs range from $100 to $200, she said. —