PHOENIX — Rebuffed last year in his bid to impose a work requirement on Medicaid recipients, Gov. Doug Ducey is trying again.
But his new proposal, to be submitted later this month, will be scaled back from the one federal officials rejected. The governor is offering new exceptions and a limit on how much time someone needs to spend on a job or in training each week to keep receiving benefits.
And something else is different: The people who will review the plan in Washington, D.C. The new administrators at the Centers for Medicare and Medicaid Services, now under the direction of President Trump, have suggested they’re more amenable to the idea than was the Obama administration, said Christina Corieri, the governor’s health adviser.
Corieri said Arizona will once again ask to put a five-year lifetime limit on benefits, which it is required to do under a 2015 state law. But she acknowledged that is likely to be rejected as it was last year.
Even with that, she figures the work requirement will affect “tens of thousands” of people who are currently getting care from the Arizona Health Care Cost Containment System, the state’s Medicaid program.
Ducey signed the 2015 legislation, which requires the state to annually seek permission to impose work requirements on Medicaid recipients and to kick them out of the health-care program after five years. Gubernatorial press aide Daniel Scarpinato said at the time that the measure will “ensure that we have a responsible Medicaid program that protects taxpayers and provides care to those who need it the most.”
That view, however, was not shared by Ducey’s predecessor, fellow Republican Jan Brewer, who vetoed nearly identical legislation a year earlier. Brewer said kicking potentially a half-million people out of the Medicaid program would not only harm them but bring the state’s health-care system “to a breaking point.”
“As we all know, their medical needs will still exist,” Brewer wrote in her veto message. She said those who would lose their health insurance through Medicaid would instead show up in hospital emergency rooms, get care there and then be unable to pay their bills.
AHCCCS provides free care to individuals and families making up to 138 percent of the federal poverty level. That’s currently about $28,180 for a family of three.
Current federal law does not allow states to impose additional requirements. But the Centers for Medicare and Medicaid does permit states to seek waivers if they can show a good reason.
That’s what Arizona is trying to do here.
The key is a proposed work requirement for anyone at least 19 years old. That’s the same proposal rejected last year.
But Corieri said the proposal being submitted has additional exceptions.
For example, she said, it would not apply to anyone at least 55 years old. There also would be exceptions for adults who are the sole caregivers of a child younger than 6 or for a disabled or elderly adult.
Other exemptions range from former foster youths up to age 26, individuals determined to have serious mental illness, victims of domestic violence, the homeless and those who have been “impacted by a catastrophic event such as a natural disaster or the death of a family member living in the same household.”
Corieri also said the requirement to work could be fulfilled by someone in schools, including community colleges and universities as well as those pursuing a GED or taking courses in English as a second language. And to sweeten the package in hopes of getting federal approval, the work requirement would be considered met if an individual engaged in any of these activities for at least 20 hours a week.
Also, “We are allowing community service to count towards that for individuals who are transitioning out of prison because of the difficulties they often have in getting a job,” Corieri said.
And those who live in areas of high unemployment — a figure that’s not defined in the state’s request — also could keep their health care without working or going to school.
In submitting an informal pre-request to the Centers for Medicare and Medicaid, AHCCCS Director Tom Betlach promoted the proposal as not only financially and economically sound but also furthering the federal agency’s goal of promoting health.
“It is well-recognized that the determinants of health include social and economic factors including education and employment,” he wrote. “We must support Arizonans in pursuing their educational goals, building their technical skills and gaining the income, independence and fulfillment that come with employment.”
Corieri said she cannot say exactly how many people are affected or how much the state could save with the restrictions.
During the 2015 legislative debate, budget staffers said the estimated savings to the state if all the waivers sought were granted probably would be less than $2 million a year. But Sen. Nancy Barto, R-Phoenix, who pushed the proposal, said it’s not just state dollars that concern legislators.
“What we’re trying to do as states ... is to take control in some way and stop incentivizing for those people that use it in that respect,” she said.
“We want certain controls in order to help the federal government keep its obligation that they’ve made, contract with the poor receiving health care,” Barto said. “But we want to make sure that we’re really serving those that are needy.”
While the Obama administration rebuffed Arizona’s request last year to impose work requirements and impose a five-year limit on benefits, it did agree to some of the other things the state sought.
Arizona is now permitted to impose a fee of up to 2 percent of household income on those who are above the poverty level — $20,420 for a family of three — but still eligible for AHCCCS. That fee, with a $25 monthly maximum, goes into a “health savings account which enrollees could use for services not covered by AHCCCS like dental, vision and chiropractic care, recognized weight-loss programs, nutrition counseling, gym membership and sunscreen.
And while the federal agency rejected the work requirements, it did approve letting the state enroll AHCCCS recipients into job-seeking programs.
