Common use of Plaintiffs’ Claims Clause in Contracts

Plaintiffs’ Claims. In the Complaint, Plaintiffs assert three separate claims: (1) improper exclusion of qualified individuals from covered medical assistance under the Medicaid Act; (2) violations of Medicaid comparability; and (3) violations of reasonable promptness. Compl. ¶¶ 64-72; Am. Compl. ¶¶ 64-72. The claims all arose out of a coverage policy that Defendants applied to Kansas Medicaid enrollees seeking coverage of DAAs (“HCV Policy”). Plaintiffs alleged that the HCV Policy excluded care that was medically necessary, and that the exclusion was inappropriately imposed based on the cost of DAAs. Specifically, Plaintiffs challenged the HCV Policy’s exclusion of coverage for certain HCV-infected enrollees based on fibrosis scores.