Peter Alvarez v. Thomas Betlach

MEMORANDUM

In this § 1983 suit, a group of Medicaid-eligible Arizonans, each of them incontinent of bowel and bladder, alleges that the Arizona Health Care Cost Containment System Administration (“AHCCCS”) violates federal law by refusing to cover incontinence briefs prescribed to adults for preventative purposes rather than as treatment for skin breakdowns. Circuit Judge Tashima, sitting as a district judge, ruled for the plaintiffs on cross-motions for judgment on the pleadings. We affirm, but reverse the award of retroactive monetary damages.

1. Federal law requires that “[a] State plan for medical assistance must ... provide ... for making medical assistance available ... to all [eligible] individuals.” 42 U.S.C. § 1396a(a)(10). This provision, as well as 42 U.S.C. § 1396a(a)(17) and 42 C.F.R. § 440.230 (d), prohibits states from denying coverage of “medically necessary” services that fall under a category covered in their Medicaid plans. See Beal v. Doe, 432 U.S. 438, 444 , 97 S.Ct. 2366 , 53 L.Ed.2d 464 (1977). AHCCCS covers “nursing facility services,” see 42 U.S.C.A. § 1396a(a)(10)(D), which, in turn, means that it must cover “home health services,” see 42 U.S.C. §…