Arizona GOP tries to speed up Medicaid disenrollment

PHOENIX - Hundreds of thousands of Arizonans are at risk of losing their Medicaid coverage over the next year because they are no longer eligible, and some state lawmakers are looking to speed up the disenrollment process.

But administrators at the Arizona Health Care Cost Containment System have put months of work into a yearlong disenrollment plan, so critics are asking why speeding up the process is necessary.

House Bill 2646, introduced by House Majority Leader Leo Biasiucci, would force AHCCCS to redetermine the eligibility of all 2.4 million the patients it serves by the end of 2023. Those whose eligibility cannot be determined would be dropped from coverage.

However, AHCCCS already has a plan in place, at the direction of the federal government, to reevaluate the eligibility of all of its members. That process is set to be completed at the start of March 2024, just three months after Biasiucci's legislation proposes.

Medicaid systems across the country were prohibited from dropping enrollees during the COVID-19 pandemic and received federal funding during that time to help pay the extra costs from keeping everyone enrolled. Continuous enrollment for Medicaid ends March 31 and federal funding runs out at the end of 2023.

And beginning in April, AHCCCS employees are set to begin contacting enrollees to confirm their eligibility.

"Right now, it's costing us $5 million per month for people who don't qualify," Biasiucci, a Republican from Lake Havasu City, told the House Health and Human Services Committee during a Feb. 16 meeting.

"Whatever it takes to get them off faster, let's do it."

Around 75% of renewals can be completed automatically, but for the rest, Medicaid will have to contact the enrollee and ask for proof that the person or family still qualifies for coverage.

Rep. Amish Shah, a Phoenix Democrat, expressed concern that if this bill is signed into law, and takes effect 90 days after the legislative session ends - presumably in June - it would put a significant squeeze on AHCCCS to complete the work by the end of the year.

Biasiucci answered that the organization should begin disenrolling members as quickly as possible, even before the bill is signed into law.

Democratic Rep. Alma Hernandez, of Tucson, said she worries that, if the timeline is sped up, people with serious conditions would be kicked out of AHCCCS and might experience gaps in health insurance coverage, and have to forgo necessary treatment.

"I think that they're going to be fine, personally," Biasiucci said. "I think cutting it short three months is not going to be that big of a deal."

Willa Murphy, a lobbyist for AHCCCS, told the committee that pushing up the deadline for disenrollment would require more staff, at a cost of around $16.7 million. AHCCCS's official stance on the bill was neutral.

But other health care organizations opposed the bill. Jennifer Carusetta, a lobbyist for Phoenix Children's Hospital, told lawmakers that the state should stick to the original timeline for re-enrollment.

"If a patient is not eligible, we want to make sure they have time to identify an alternate source of coverage," she told the committee.

Finding a new source of coverage might be easy for some families and more challenging for others, Carusetta said. Those families might have to find a new source of coverage, be approved for it and ensure they have a care team in place that is in-network for that insurance before being dropped from AHCCCS, to ensure continuity of care.

The state Medicaid program has a plan in place to help ensure continuous coverage for its most vulnerable patients who no longer qualify, she added.

Carusetta also noted that it is also extra challenging for AHCCCS to contact homeless patients to verify their eligibility, and ensuring they know their coverage is in jeopardy could take significant time.

The Arizona Medical Association also opposes the bill. Its lobbyist, former Ducey administration health care advisor Christina Corieri, pointed out that the legislation would kick off all patients whose eligibility hasn't been confirmed at the end of 2023, not just those who were determined to be ineligible.

This might mean that if AHCCCS can't finish its redeterminations by the bill's deadline, people who are eligible but who haven't made it through the redetermination process would be kicked off of their health plan.

Republican Rep. Matt Gress, of Phoenix, agreed with the association's concern and said he'd be interested in amending the bill to change that.

Gress also said that many of those who are no longer eligible for AHCCCS would have the option to enroll in low-cost insurance programs through the federal health insurance exchange.

The bill passed through the committee on a 5-4 vote along party lines. It heads next to consideration by the full House of Representatives.