Some immigrants with serious medical conditions aren’t getting proper treatment because of Arizona Health Care Cost Containment System errors, a lawsuit filed by two advocacy groups alleges.

The William E. Morris Institute for Justice and the National Health Law Program sued AHCCCS and its director, Thomas Betlach, in U.S. District Court in Tucson on July 22, on behalf of Aita Darjee and Alma Sanchez Haro.

The groups are also seeking a class-action designation “on behalf of low-income Arizona immigrant residents who qualify for medical services through Arizona’s Medicaid program,” the lawsuit says.

It claims “computer programming and caseworker errors” have improperly withheld full AHCCCS benefits to immigrants who are eligible for Medicaid under the federal Medicaid Act.

Generally, lawfully admitted immigrants can’t receive full Medicaid benefits until they’ve been in the country for 5 years. Immigrants who may qualify for full Medicaid benefits before 5 years include refugees, asylees, victims of trafficking, veterans, battered people and lawful permanent residents, according to Medicaid.

The mistake, the plaintiffs say, stems from full AHCCCS benefits and “emergency-only” benefits. AHCCCS re-certifies benefits annually, and in that process last year, a clerical error switched some refugees to emergency-only benefits, which cover only emergency situations, not ongoing medical treatment like medications and doctors’ visits, the plaintiffs say.

The emergency-only benefits cover events that “place the member’s health in serious jeopardy, serious impairment to bodily functions, serious dysfunction of any bodily organ or part, or serious physical harm to another person,” according to Arizona Administrative Code.

AHCCCS acknowledged on its website in November 2015 that a “systems error” meant some refugees were moved onto emergency-only benefits instead of full benefits. People whose benefits were reduced were instructed to contact the department to make sure their coverage was corrected.

But, the plaintiffs allege, not all whose benefits were reduced have been helped. The plaintiffs say they notified AHCCCS of the problem in October 2015. Since then, more than 3,500 immigrants have gotten their full AHCCCS benefits back, but the system is still improperly transferring immigrants to emergency-only benefits, the plaintiffs say, meaning some people have seen reductions twice in the past year.

“We want AHCCCS to fix the system so that these persons, who often are very vulnerable, continue to get the benefits they’re eligible to receive,” said Ellen Katz, attorney for the William E. Morris Institute for Justice.

Darjee and her family, refugees from Nepal living in Tucson, were transferred to emergency-only benefits twice in the past year, the lawsuit claims. Darjee’s husband, Dambar, has high blood pressure and diabetes, which emergency-only benefits didn’t cover, the lawsuit says. Darjee and the couple’s son also need doctors’ visits for ongoing health issues, but emergency-only benefits won’t cover those. The notices from AHCCCS don’t come in Nepali, they say.

“The thought of not being able to see their doctors and get their medications has caused them a lot of worry. They are very stressed over this situation. Darjee is especially worried about her husband,” the lawsuit says.

Sanchez Haro, who, as a victim of domestic violence is eligible for full Medicaid benefits, was informed that her benefits changed to emergency-only despite no change in immigration status. She suffers from severe depression, anxiety, diabetes, high blood pressure, high cholesterol and muscle cramps, which require ongoing visits to the doctor and medications. Without full benefits from AHCCCS, she can’t afford treatments, the lawsuit says.

“The 2-3 weeks she was off her medications were horrible for her. She was trembling, shaking, vomiting and her head burned. She was suicidal and very depressed,” the lawsuit says.

The plaintiffs also say notifications that AHCCCS sends out that tell people they are only eligible for emergency-only benefits violate federal law.

“These drastic reductions in Medicaid services are unwarranted and unjust. We claim that Arizona Medicaid officials are running afoul of the Medicaid rules, jeopardizing the health of scores of qualified beneficiaries,” said Cori Racela, staff attorney for the National Health Law Program.

AHCCCS Deputy Director Beth Kohler said the agency can’t comment on any pending litigation.

Ahcccs-Lawsuit (Text)