Arizona closer to adding Medicaid job requirements as Trump opens door

Arizona is closer to adding work requirements for some low-income people on AHCCCS after the Trump administration said Thursday that it will allow states — for the first time — to require “able-bodied” Medicaid recipients to work.

Arizona is one of 10 states that have submitted applications to add work requirements for the government health insurance program for low-income people.

The state’s Medicaid program, which is called the Arizona Health Care Cost Containment System or AHCCCS, submitted its final application on Dec. 19 to the federal government’s Center for Medicare and Medicaid Services. The Arizona application calls for adding both work requirements and five-year lifetime limits on Medicaid enrollment.

The changes would apply to “able-bodied” adults, who are physically and mentally capable of working and not medically frail, the application says.

The application clarifies some language about who would be exempt from the work requirements and the lifetime limits. State officials added more exemptions and specifics to the application after holding public forums and a public comment period which yielded overwhelming criticism.

Homeless people, former foster children and American Indians are among individuals who would be exempt from Arizona’s proposed Medicaid work requirements, the state’s application says.

The proposed Arizona policy change originated with a state law passed in 2015 by legislators who say work requirements incentivize people to gain financial independence from government support and are also critical to maintain Medicaid’s viability.

Critics worry that kicking people off Medicaid for not having a job will penalize a small number of vulnerable Arizonans, and force them to get care in emergency rooms, which in the end is more costly for the health-care system.

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The U.S. Medicaid program has grown by double digits in states like Arizona that expanded Medicaid under the Affordable Care Act.

The latest Arizona numbers show 1.8 million Arizonans — one in every four state residents — currently has health coverage through Medicaid. Nearly 300,000 Pima County residents are covered by AHCCCS.

A federal comment period on Arizona’s 683-page application is open through Feb. 5.

AHCCCS officials say the waiver request is designed to provide low-income, able-bodied adults “the tools needed to gain and maintain meaningful employment, job training, and education.”

Arizonans who don’t qualify for an exemption would have to work, be actively looking for work, or be in school or job training for at least 20 hours per week. In certain cases, community service hours may substitute for work, the application says.

Included on the extensive list of Arizonans who would be exempt from work requirements are people younger than 19 and older than 55; victims of domestic violence; individuals with serious mental illness; American Indians; people who are homeless; former foster youths up to the age of 26; pregnant women; full-time students; people recently impacted by a death or catastrophic event; and caregivers of a family member enrolled in the Arizona Long Term Care System, the application states.

“We are ‘in the queue’ for CMS’ review and response,” AHCCCS spokeswoman Heidi Capriotti wrote in an email. “With their approval, the work of systems development and design would begin within six months.”

Full operational implementation will depend upon many variables yet to be finalized, she said.