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Posts Tagged ‘Medicare’

In 2003, Arizona requested a waiver from the Secretary of Health and Human Services (“the Secretary”) to expand its mandatory Medicare co-payments for (1) childless, nondisabled adults who earn up to 100% of the federal poverty level and (2) former recipients of state health care benefits in order to lower health care costs and close a $1 billion budget gap. The Secretary granted the waiver in 2004.

After the waiver was granted, a group of "economically vulnerable" Arizonans filed a class action against the Secretary and the director of Arizona’s Medicaid agency, alleging that (1) the increased and expanded mandatory co-payments violated the Medicaid Act’s cost-sharing restrictions, (2) the waiver was illegal, and (3) they had received inadequate notice of the changes. The trial court ruled that the plaintiffs, while vulnerable, were not defined as a "medically needy" population under the Medicaid Act. Because Arizona’s state health care plan does not cover them, the trial court found that the state was exempted from the law’s cost-sharing provisions as an "expansion population."

On appeal, the Ninth Circuit Court of Appeals agreed on this point, but remanded the case for a new look at the waiver and notice issues because of the following:

There is little, if any, evidence that the secretary considered the factors [federal statute] requires her to consider before granting Arizona’s waiver. . . . The record is not sufficient for this court to review the agency’s consideration of the impact Arizona’s demonstration project would have on the economically vulnerable.

For the full story, click here.

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