Case: DOJ Investigation of Alabama Medicaid

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Case Summary

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…

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)

Documents in the Clearinghouse

Document

Settlement Agreement Between the United States of America and the State of Alabama's Medicaid Agency

Dec. 5, 2022

Dec. 5, 2022

Settlement Agreement

Docket

Last updated Aug. 30, 2023, 1:36 p.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: Alabama

Case Type(s):

Disability Rights

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):

Jurisdiction-wide

Case Details

Causes of Action:

Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.

Available Documents:

None of the above

Outcome

Prevailing Party: Plaintiff

Nature of Relief:

Injunction / Injunctive-like Settlement

Source of Relief:

Settlement

Form of Settlement:

Private Settlement Agreement

Content of Injunction:

Discrimination Prohibition

Develop anti-discrimination policy

Post/Distribute Notice of Rights / EE Law

Reporting

Order Duration: 2022 - 2024

Issues

General/Misc.:

Government services

Public benefits (includes, e.g., in-state tuition, govt. jobs)

Benefits (Source):

Medicaid

Disability and Disability Rights:

Mental Illness, Unspecified

Discrimination Basis:

Disability (inc. reasonable accommodations)

Discrimination Area:

Pay / Benefits

Medical/Mental Health Care:

Hepatitis

Medical care, general

Medical care, unspecified

Mental health care, general

Mental health care, unspecified