650,000 in Arizona could lose Medicaid

The latest numbers show 2.5 million Arizonans are enrolled in the state's Medicaid program, which is called the Arizona Health Care Cost Containment System. And AHCCCS leaders as of February had identified more than 25% of current enrollees, or an estimated 674,460 people, who are at risk of getting kicked out of the program over the next year as the state agency reviews cases in a process often called redetermination or "the unwinding process."

Arizona's two most populated counties have the highest number of people at risk of losing coverage ― an estimated 389,000 residents of Maricopa County, and 98,000 in Pima County could be disenrolled over the next year, AHCCCS data shows.

The reason for a potential mass disenrollment is one facing Medicaid programs across the country. Throughout the COVID-19 pandemic, AHCCCS and other state Medicaid programs froze disenrollment, which means the number of people enrolled grew and grew, with few exceptions, generally only for death, voluntary disenrollment, moving out of state or aging out of programs with age limits.

"It's huge. ... We know that there are folks out there who don't realize they are about to lose their coverage," said Kelley Murphy, vice president of policy for the Phoenix-based Children's Action Alliance. "It's very scary when you think about the number of people who could be impacted."

Murphy's organization, along with AHCCCS and other community groups, is working to get the word out.

"Despite that, we still don't believe that everyone is aware that this is happening," Murphy said. "The big fear is that a family loses their coverage and their child has an emergency and they go to an emergency room and don't realize they aren't covered."

Officials with the state's $18 billion AHCCCS program are working with the Arizona Department of Economic Security on the redeterminations over the next year, and DES is adding employees to handle the added work, AHCCCS Deputy Director Kristen Challacombe said.

Challacombe characterized the redetermination process as both historic and monumental, and a major undertaking for both AHCCCS and DES.

Total national enrollment in Medicaid and the federal Children's Health Insurance Program grew to 90.9 million people in September 2022, an increase of 19.8 million or more than 27.9% over February 2020, according to the Kaiser Family Foundation.

Medicaid is the single largest source of coverage for U.S. children, with 54.3% of all children in the country enrolled in Medicaid and CHIP, a report from Georgetown University's Center for Children and Families says.

"The potential impact of the unwinding process could double the nation’s uninsured rate for children if not handled well, and worsen existing racial disparities in access to health coverage and care," the Georgetown report says. "Families with high levels of recent residential instability, limited English proficiency, or limited internet access are at greater risk of losing coverage."

How to avoid getting kicked off AHCCCS

AHCCCS enrollees have ways to make sure they don't get a disenrollment notice on April 1, provided they still qualify for the program.

AHCCCS has a toolkit and various groups have been providing messaging, including radio ads and flyers in churches and other community hubs, about how to prevent or prepare for disenrollment.

The AHCCCS website has a section for frequently asked questions about the redetermination process. AHCCCS is asking all members to make sure their mailing address, phone number and email address on file are correct in Health-e-Arizona Plus. Enrollees may log in to www.healthearizonaplus.gov or call 1-855-HEA-PLUS (1-855-432-7587) from 7 a.m. to 6 p.m. Monday through Friday. Enrollees may sign up for text or email alerts from AHCCCS at www.healthearizonaplus.gov.

Members will only be disenrolled if they no longer meet eligibility requirements or do not respond to requests from AHCCCS for more information through the renewal process. And AHCCCS officials must make a good-faith effort to notify people before disenrolling them.

If AHCCCS enrollees are now earning too much money to qualify for the program, they may be able to afford coverage, with federal subsidies to help pay for it, through the Affordable Care Act or Obamacare plans. There's a special enrollment period for ACA coverage for qualified individuals and their families who lose Medicaid or KidsCare (the federal Children's Health Insurance Plan, known as CHIP) coverage starting March 31 and ending July 31, 2024, federal officials recently announced.

About half of the people at risk for disenrollment are earning too much money to qualify for AHCCCS, and those people may want to seek other coverage before they are kicked out of the program. Members who are no longer eligible for Medicaid will see a referral to healthcare.gov on their discontinuance notice, AHCCCS officials say.

Cover Arizona has no-cost health insurance enrollment assistance, with virtual or in-person options available. Visit www.coveraz.org/connector or call 1-800-377-3536 or 2-1-1 for an appointment.

The Children's Action Alliance and other groups, including the Arizona Alliance for Community Health Centers, the Health System Alliance of Arizona and the Vitalyst Health Foundation, are opposing a bill in the Arizona Legislature that would cut off the disenrollment process on Dec. 31 rather than on March 31, 2024.

"It would be disastrous," Murphy said of the bill. "It's difficult enough to do in 12 months."

Critics say the bill could result in uncertainty, confusion, and some people could be prematurely removed from AHCCCS if it's signed into law. The sponsor of the bill is House Majority Leader Rep. Leo Biasiucci, a Republican from Lake Havasu City. The bill passed the Legislature's Health and Human Services Committee 5-4 on Thursday. The votes were split along party lines, with Republicans in favor and Democrats against.

"We owe it to the taxpayers and to the truly needy who depend on this program to remove these ineligible individuals before the extra federal funding runs out at the end of the year," Biasiucci wrote in an email to The Arizona Republic this week.

"Worse, the Biden Administration is encouraging states to keep ineligible people on Medicaid for a year or longer because they want as many people on welfare as possible. We should be operating on Arizona's schedule, not Joe Biden's."

Medicaid programs across the U.S. affected

Medicaid/AHCCCS is a government health insurance program for low income people. Eligibility levels vary depending on categories and the number and age of children who are covered, but generally for a single adult in Arizona, the qualifying household income is $19,392 per year or less.

The Families First Coronavirus Response Act prevented Arizona and other states that accepted increased federal Medicaid matching dollars during the pandemic from dropping anyone who was enrolled as of March 18, 2020. States that accepted the enhanced funding also couldn't remove any new enrollees, either. As a result, enrollment grew and uninsured rates dropped.

While the freeze on disenrollment had been tied to the federal public health emergency, that changed as part of a congressional end-of-the-year spending bill. The Consolidated Appropriations Act, which was signed into law Dec. 29, says states that accept the enhanced federal funding can resume disenrollments beginning April 1. The federal public health emergency is set to end May 11.

The Kaiser Family Foundation estimates that between 5 million and 14 million people could lose Medicaid coverage over the next year as a result of the disenrollment freeze lifting.

In Arizona, enrollment in AHCCCS has jumped 34% since July 2019, and its enrollment of 2.5 million people is a record high for the program, which launched in 1982. In March 2022, an estimated 500,000 AHCCCS members were at risk of losing coverage. But estimates of the number of AHCCCS members at risk of disenrollment went up as numbers in the program have continued to rise.

U.S. Rep. Raúl Grijalva, D-Ariz., on Jan. 25 sent a letter to AHCCCS Director Carmen Heredia encouraging her to "take every possible action to ensure Arizonans can smoothly renew coverage, or transition to other available coverage if they are no longer eligible for Medicaid or CHIP."

Specifically, Grijalva asked about language supports, the capacity of the AHCCCS technology to withstand use by hundreds of thousands of people, and the agency's plans for engaging with stakeholders.

In a Feb. 2 response, Heredia wrote that AHCCCS has used text messages and robocalls to alert members to update their contact information, and mass communication tools such as social media, web content, newsletters, and announcements in public meetings.

In addition, she said the AHCCCS technology has been load tested, and the agency and its managed care organizations have provided written materials and social media posts in Spanish and English. They also have asked their community partners to translate materials into languages that their stakeholders use most, she wrote. In addition, AHCCCS has created a video in American Sign Language, at https://youtu.be/8tQUoY5ntoI.