AHCCCS coverage limit would hurt low-income families, critics say
A federal comment period on
The federal government has already approved similar requests from
Critics say the proposal, if approved, would financially punish vulnerable people.
Proponents say the change would more closely align Medicaid policies with commercial health insurance coverage and ensure Medicaid's long-term sustainability. In
The government health insurance program for low-income people has enrolled 1.8 million Arizonans -- roughly one quarter of the state's population -- including 281,380
In
State officials say retroactive three-month coverage has cost AHCCCS, which is funded with a blend of federal and state money, nearly
Under
Yet critics see the three-month buffer as an important protection for low- income people who may have gaps in coverage. They say it also ensures that individuals who may have a series of health events prior to discovering they are eligible for Medicaid do not become burdened by medical debt.
"From my perspective, there is really no good policy reason to do this. I think the clear objective of states is simply to save money," said
"Nothing in this policy is going to change the way that people have health care needs arise or the way that they are managed. Those health care needs are still there. The question is who is left holding the bag in terms of paying for them."
The Medicaid population tends to be transient, and that's one reason why the policy change could bring inherent problems for enrollees, said
Frequent address changes might mean enrollees don't receive notifications about their coverage, including whether it has lapsed, Plese said.
In other words, people may be receiving medical care but not realize they are no longer enrolled in Medicaid until the bills come in. In that way, the program's savings could become the burden of health providers, particularly those who serve vulnerable populations, Plese said.
"Rural populations in particular are really operating on a very small margin, just trying to keep their doors open," she said. "If you have a lot of uncompensated care building up in rural areas, the impact of this could be sizable."
Cost shifting
The proposed change would not affect coverage options for people enrolled in AHCCCS, agency spokeswoman
It's only retroactive coverage that will be affected, she said. And limiting retroactive payment of medical bills is not only a cost-saving measure, state officials say in their request.
State officials say it is also a way of encouraging Arizonans to continuously maintain health coverage, "even when healthy," and to apply for Medicaid "without delays to promote continuity of eligibility and enrollment for improved health status."
One concern about the policy change in
"I don't buy the argument that it encourages people to have continuous coverage," Alker said. "These people are not uninsured because they want to be."
Elderly people enrolling in the AHCCCS long-term care program are at particularly high risk with a change in retroactive coverage, wrote
As families of elderly loved ones navigate the cumbersome and complex application process for ALTCS (Arizona Long Term Care System), which is part of AHCCCS, nursing facilities need to ensure they get compensated, Johnson wrote.
"Without this guarantee, facilities may choose to deny these individuals access to care unless the family can pay upfront," she wrote.
Fiscal analysis
An
"Restricting retroactive eligibility does not further the objectives of the Medicaid program,"
"Many individuals may only realize they are Medicaid-eligible when they experience a health event or otherwise encounter the health system. Some may have experienced a series of health events leading up to the discovery of coverage eligibility."
Prior quarter coverage allows part-time and seasonal workers to move in and out of employment with some assurance of coverage,
The change would "certainly" have a financial impact on
"For us, it will mean more dollars that will fall into bad debt and charity care, which will weaken an already fragile safety net," hospital spokeswoman
Alker of Georgetown said Medicaid in the
"They are cutting people off, or shortening their coverage," she said.
"Nothing in this policy is going to change the way that people have health care needs arise or the way that they are managed...The question is who is left holding the bag in terms of paying for them ."
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