Medical Assistance Co-Payment
Law Changes
By Abigail Turner
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
