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This investigation and subsequent settlement agreement involved discrimination against individuals with Hepatitis C (HCV) and substance abuse disorder (SUD) due to non-medically indicated sobriety restrictions for HCV treatment. On December 5, 2022, the Special Litigation section of the U.S. Department of Justice’s Civil Rights Division (DOJ) announced that it had secured a settlement agreement with the state of Alabama’s Medicaid Agency to ensure that Alabama’s Medicaid recipients with HCV who also struggled with SUD had equal access to medication to treat their hepatitis, in compliance with Title II of the Americans with Disabilities Act (ADA). The DOJ found that Alabama Medicaid’s policy of requiring sobriety discriminated against individuals based on their disability status.
The settlement agreement was initiated following an investigation into complaints that Alabama Medicaid’s sobriety policy discriminated against people with HCV and SUD by requiring individuals to abstain from alcohol and illicit drugs for six months to be eligible for Direct-Acting Antiviral agents (DAA) treatment. The United States argued that the policy was non-medically indicated and constituted a violation of Title II of the ADA by denying essential care on the basis of disability.
Alabama Medicaid cooperated with the DOJ investigation while denying any wrongdoing or violation of Title II of the ADA. Nevertheless, both parties agreed to resolve the matter through a settlement agreement to ensure individuals with HCV were not subjected to the sobriety policy and received the necessary medical treatment without discrimination.
The agreement outlined that Title II of the ADA prohibits discrimination against qualified individuals with disabilities by public entities, which includes services provided under Medicaid like medical evaluation, screening, treatment, and medication. It asserted that Alabama Medicaid was subject to Title II and its implementing regulations as a public entity.
Under the terms of relief, the agreement stipulated that Alabama Medicaid would withdraw the sobriety policy effective October 1, 2022, ensuring no future denial, delay, or non-payment for DAA treatment based on a recipient’s drug or alcohol use. Alabama Medicaid committed to no longer imposing drug or alcohol use as a prerequisite for DAA treatment or establishing any new restrictions related to drug or alcohol use. It must notify all Medicaid providers, certain targeted providers, and critical state partners about withdrawing the sobriety policy and update treatment protocols accordingly.
The agreement also mandated that Alabama Medicaid notify Medicaid recipients about the policy change, encouraging them to seek HCV screening and treatment regardless of their SUD status. A website notification must be posted to inform the public about the expanded availability of HCV treatment without the sobriety policy. To ensure compliance and monitor the effective implementation of these changes, Alabama Medicaid was tasked with preparing and providing two reports to the DOJ detailing actions taken to withdraw the sobriety policy, review and remedy any denials based on drug or alcohol use, and address any complaints related to access to DAA treatment.
The agreement was set to remain in effect for eighteen months from its effective date, with a defined dispute resolution process to address any non-compliance or disputes related to its terms. The implementation and monitoring of the settlement agreement remain ongoing.
Summary Authors
(3/10/2024)
Last updated Aug. 30, 2023, 1:36 p.m.
Docket sheet not available via the Clearinghouse.State / Territory: Alabama
Case Type(s):
Public Benefits/Government Services
Key Dates
Case Ongoing: Yes
Plaintiffs
Plaintiff Description:
The Department of Justice (DOJ), investigating and securing a settlement agreement with Alabama's Medicaid Agency to end discriminatory sobriety requirements for Hepatitis C treatment, ensuring equal access for those with substance abuse disorders.
Plaintiff Type(s):
U.S. Dept of Justice plaintiff
Attorney Organizations:
U.S. Dept. of Justice Civil Rights Division
Public Interest Lawyer: Yes
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Defendants
The State of Alabama's Medicaid Agency, State
Defendant Type(s):
Case Details
Causes of Action:
Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.
Available Documents:
Outcome
Prevailing Party: Plaintiff
Nature of Relief:
Injunction / Injunctive-like Settlement
Source of Relief:
Form of Settlement:
Content of Injunction:
Develop anti-discrimination policy
Post/Distribute Notice of Rights / EE Law
Order Duration: 2022 - 2024
Issues
General/Misc.:
Public benefits (includes, e.g., in-state tuition, govt. jobs)
Benefits (Source):
Disability and Disability Rights:
Discrimination Area:
Discrimination Basis:
Disability (inc. reasonable accommodations)
Medical/Mental Health Care: