PHOENIX — Arizona’s Medicaid program will no longer be able to save money by denying incontinence briefs to potentially thousands of adults who need them.
Without comment, the U.S. Supreme Court on Monday refused to disturb an earlier ruling by the 9th Circuit Court of Appeals ordering that the items be supplied by the Arizona Health Care Cost Containment System. That ends the legal dispute.
The fight is over a federal law that requires AHCCCS to provide “medically necessary” services to those eligible for coverage. That includes anyone whose income puts them below 138 percent of the federal poverty level, about $16,100 a year for individuals and $27,300 for a family of three.
AHCCCS officials concede that point but argued the briefs for adults do not qualify for coverage.
Agency lawyers said briefs are medically necessary only when prescribed to treat skin breakdown or infection due to incontinence.
In this case, the state said, the briefs were being prescribed by doctors ahead of any indication of an actual medical problem.
In a ruling earlier this year, however, the appellate judges said that contention is contrary to AHCCCS’ own regulations which say services are medically necessary when provided by a doctor “to prevent disease, disability, or other adverse health conditions or their progression.”
And in this case, the judges said, even AHCCCS admitted the briefs were, in fact, being prescribed for preventative purposes.
After losing the case in federal district court, AHCCCS began providing the briefs — but only for 11 individuals who were represented by the Arizona Center for Disability Law. Attorney Sarah Kader said one has since died.
Monday’s action by the Supreme Court forces the agency to now make the items available to anyone who has a doctor’s order declaring them medically necessary.
“We expect that it totals thousands,” Kader said.
Calls to AHCCCS seeking comment, cost estimates and number of people affected were not immediately returned.