AHCCCS faces class-action lawsuit for cutting autism coverage in Arizona

Class-action lawsuit filed against Arizona’s Medicaid program is challenging cuts to children’s autism coverage. A group of families has come together to take legal action against the Arizona Health Care Cost Containment System (AHCCCS) in response to the reduced coverage that affects children diagnosed with autism spectrum disorder.

The lawsuit, which was filed in Maricopa County Superior Court, alleges that AHCCCS did not demand that insurers maintain an adequate network of providers for children with autism spectrum disorder. The families are seeking an immediate injunction to halt or reverse AHCCCS’ approval of insurers’ decisions to eliminate in-network applied behavior analysis (ABA) coverage. This decision could impact up to 1,000 children in Arizona who rely on this form of therapy.

The recent approval by AHCCCS to end in-network coverage for the state’s two largest ABA providers has put families in a difficult position. Parents like Melissa Fernandez, whose son Colin, diagnosed with severe autism spectrum disorder at two years old, have seen substantial progress through ABA therapy.

Fernandez, a member of Mercy Care, expressed concerns about the potential regression her son might experience due to the insurer’s decision to no longer cover their current providers. She shared how Colin looks forward to therapy each day, and the cancellation notice from Mercy Care was devastating for their family.

The families involved in the lawsuit, represented by attorney Tim Nelson, argue that the existing waiting lists for autism providers are already extensive. If families are forced to find alternative in-network providers, it would create further hardship. Nelson emphasized the illegal nature of AHCCCS allowing these cuts to provider networks to occur, stressing the potentially devastating consequences for many Arizona children and families.

The lawsuit has five counts against AHCCCS, citing violations of various laws, including the federal Medicaid Act, the Americans with Disabilities Act, the Developmental Disabilities Act, the Arizonans with Disabilities Act, and the Arizona Constitution.

The families involved are fighting for the rights of children with autism and are determined to ensure access to necessary care and support for those in need. The class-action lawsuit represents a collective effort to address the significant impact that these coverage cuts have had on families in Arizona. By taking legal action, they aim to protect the well-being and progress of children with autism in the state.