Deadline to comment on proposed AHCCCS changes is Wednesday

March 26--The public still has time to give input on a state proposal to put work requirements and lifetime limits on Arizonans enrolled in Medicaid.

The proposal has been rejected once, but under the Trump administration appears to have a higher chance for approval.

The comment deadline is Wednesday, March 29 -- an extension from the prior deadline of Feb. 28. Medicaid is a government insurance program for low income people. In Arizona the program is called the Arizona Health Care Cost Containment System (AHCCCS).

Arizona must re-apply to the Centers for Medicare and Medicaid Services to make the changes by March 30.

Able-bodied

The proposed changes were spelled out in a state law -- Senate Bill 1092 -- that passed in 2015. Among those changes is putting a five-year limit on enrollment for "able-bodied" Arizonans, and also imposing a requirement that would able-bodied people enrolled in AHCCCS be employed, looking for work, in school or in job training.

"Able-bodied" in SB 1092 is broadly defined as anyone over the age of 19 who is mentally and physically capable of working. There are exceptions, including anyone over the age of 19 who is still in high school; sole caregivers of children under age 6; and anyone receiving long-term disability.

The legislation also allows AHCCCS officials to ban enrollees for a year if they knowingly failed to report a change in family income or made false statements about their compliance with work requirements.

In 2016, the federal government rejected SB 1092's lifetime limit and work requirement proposals on the grounds that those requests could undermine access to care. But SB 1092 says AHCCCS must reapply by March 30 each year.

And the federal government could have a different reaction this time.

Letter to governors

A March 14 letter to the nation's governors co-written by new secretary of U.S. Health and Human Services director Dr. Tom Price and new U.S. Centers for Medicare & Medicaid Services (CMS) administrator Seema Varma says the federal government wants to give states more freedom to run their Medicaid programs.

"Today, we commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population," the letter from Price and Varma says.

"States, as administrators of the program, are in the best position to assess the unique needs of their respective Medicaid-eligible populations and to drive reforms that result in better health outcomes."

The letter also says that expanding Medicaid to non-disabled, working age adults without dependent children, "was a clear departure from the core, historical mission of the program."

Arizona restored Medicaid (AHCCCS) to childless adults in 2014 at the same time it expanded Medicaid under the Affordable Care Act (ACA).

To date, CMS has not approved any state's request to require that Medicaid beneficiaries work as a condition of eligibility. Four states to date have applied for waivers allowing for them -- Arizona, Indiana, Pennsylvania and Kentucky, a Kaiser Family Foundation issue brief says.

The proposed American Health Care Act (AHCA), which had been scheduled for a vote in Congress last week, includes a state option to make Medicaid eligibility for nondisabled, nonelderly, non-pregnant adults conditional upon satisfaction of a work requirement. A vote was called off at the last minute on Friday.

Critics

A Jan. 27 Tucson public hearing about the proposed changes in Arizona yielded an overwhelmingly negative reaction from the approximately 90 people in attendance.

Among populations that could be shut out of health care if the restrictions were to be put in place are adults who are caregivers for disabled children or elderly relatives; people with felonies who have trouble finding jobs; and people living in rural areas, state officials were told.

Kicking people off of Medicaid because of the lifetime limit or work requirement will result in more uninsured people seeking care in emergency rooms, the critics said. Ultimately it would end up denying health care to some of Arizona's poorest residents, they argued.

AHCCCS currently enrolls more than a quarter of Arizona's population, or 1.9 million people, including nearly 300,000 residents of Pima County, the agency's March enrollment numbers show.

Contact health reporter Stephanie Innes at 573-4134 or email sinnes@tucson.com On Twitter: @stephanieinnes

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