PHOENIX — 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 both federal laws and regulations requiring programs funded with federal dollars to provide all necessary medical supplies to those 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 the AHCCCS to start supplying the briefs. And she seeks reimbursement for patients throughout the state who have had to pay for them.
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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."
At the heart of the fight is the policy of the AHCCCS, the state's Medicaid program, to provide incontinence briefs to those 21 and older who are disabled and incontinent, but only when they are ordered by a doctor to treat skin breakdown or infection.
The problem, said Nye, is that the AHCCCS will not pay for doctor-ordered briefs that she said are "medically necessary to prevent skin breakdown and infection and to allow integration into the community."
Yet, Nye said, the agency will provide preventive 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.
