Medical Assistance Co-Payment Law Changes

Ramsey County District Court Judge Teresa R. Warner ruled on September 21, 2005 that Minnesota’s Medical Assistance co-payment law violates […]

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Ramsey County District Court Judge Teresa R. Warner ruled on September 21, 2005 that Minnesota’s Medical Assistance co-payment law violates the federal Medicaid Act. This law permits providers to deny services to low-income people if they cannot afford the co-payment.

Six Minnesotans on Medical Assistance, the Minnesota affiliate of the National Alliance for the Mentally Ill, and the Minnesota Psychiatric Society filed this lawsuit on July 26, 2004, because the Department of Human Services’ policies are denying Medical Assistance recipients access to critical medical care in violation of federal law.

The Legislature imposed co-payments, beginning October 1, 2003, for drugs, doctor and hospital visits, and eyeglasses. Minnesota’s co-payment law states that medical providers cannot deny services to persons who cannot afford the co-payments. The federal Medicaid Act requires this language.

Minnesota, however, allows medical providers to refuse service to a person who has a co-payment debt if it is the routine practice of the provider to refuse such service. Plaintiffs claimed that this additional language violates the Medicaid Act.

Each of the individual plaintiffs has severe physical or mental disabilities and each is low-income. Two are parents of children for whom they are responsible. Mid-Minnesota Legal Assistance represents the plaintiffs.

Pharmacies in the metro area have consistently told the plaintiffs that they cannot get medicine unless they pay the co-payment. Some doctors’ offices will not make an appointment until MA eligible persons have paid any past due co-payments.

The Court held that the Minnesota law “. . . directly conflicts with [the] federal statute 42 U.S.C. ‘ 1396o(e). The state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress.” Judge Warner ruled that Minnesota’s law “is preempted by federal law.”

Sue Abderholden, Executive Director of NAMI, praised the Court’s ruling. Ms. Abderholden commented: “Many people with mental illness and other disabilities have been denied medicines because they could not afford a co-payment. Their ability to function and lead a full life was threatened. This is a very important victory for them and all persons on Medical Assistance.”

The Court also held that the right to receive medical care and services is such a fundamental and direct right for recipients that it “cannot be taken away without notice and an opportunity for a hearing.” Minnesota’s practice “to deny care and services to recipients without notice and a hearing has been preempted” by the federal statute. However, since Minnesota’s provision is no longer in effect, the Court found that the issue is moot.

The Court declined to require the state to refund monies Medical Assistance recipients paid to providers under the illegal Minnesota law. The Court also denied class certification because the order applies to all persons on Medical Assistance.

Abigail Turner is the Litigation Director at Mid-Minnesota Legal Assistance

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