Putting a work requirement and five-year lifetime limit on people receiving Medicaid will deny health care to some of Arizona’s poorest residents, a Tucson crowd told state officials Friday morning.
The proposals were rejected by the federal government once, but Arizona is resubmitting them and seeking public input. Medicaid is a government insurance program for low-income people.
“There’s never been a waiver (change to Medicaid rules) like this approved in the country ever,” said Beth Kohler, deputy director of Arizona’s Medicaid program, which is called the Arizona Health Care Cost Containment System (AHCCCS). “But we do have a new administration” under President Trump, she noted.
Kohler stopped her presentation several times because of questions from audience members, some of them AHCCCS enrollees. A few were scared, others confused.
Critics said several populations of adults could be shut out of health care under the proposed changes, including those who are caregivers for disabled children or elderly relatives; people with felony convictions who have trouble finding jobs; and people living in rural areas. People with disabilities, including mental illness, are not explicitly exempt, several attendees noted.
Cost shift
About 90 people attended the public hearing on the proposed changes, held Friday at Banner-University Medical Center South, and their reaction was overwhelmingly negative. AHCCCS officials hosted the two-hour hearing.
Kicking people off of Medicaid because of the five-year lifetime limit or work requirement will result in more uninsured people seeking care in emergency departments, many said.
“What is being spelled out here is an absolute evisceration of certain communities,” said Michelle Crow, Southern Arizona director of the Children’s Action Alliance.
“I think people think of this as targeting individuals, but it really targets communities. Get public comment from Morenci, Douglas, Yuma. ... It’s not going to be a cost savings. It’s a cost shift,” she said.
SB 1092
The proposed changes were spelled out in a state law — Senate Bill 1092 — approved in 2015. The intent of the law was to move able-bodied Arizonans off of taxpayer-funded health care.
Among the law’s provisions is putting a five-year limit on enrollment for able-bodied Arizonans with certain exceptions (including having a job), and also imposing a requirement that able-bodied people enrolled in AHCCCS be employed, looking for work, in school or in job training.
Under terms of the state law, Arizona must reapply to the federal Centers for Medicare and Medicaid Services to make the changes by March 30. The changes in SB 1092 can’t take effect without federal approval.
SB 1092 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.
- Calls for developing cost-sharing requirements to deter the use of ambulance services for nonemergency transportation when not medically necessary.
- Requires people to verify compliance with work requirements monthly.
One of the biggest quibbles that the Tucson audience had with the proposals is the term “able-bodied.”
“Able-bodied” is broadly defined as anyone over age 19 who is mentally and physically capable of working. There are some exceptions, including anyone over 19 who is still in high school; sole caregivers of children under the age of 6; and anyone receiving long-term disability.
But those who spoke at the forum felt there were too many categories of people who were not exempted and could be unfairly affected by the restrictions, including people with chronic illness and behavioral health problems.
“Greater barriers”
Crow and others said the changes are shortsighted and do not take into account the reasons that people might be on Medicaid.
“It will result in a loss of coverage with little or no gain in long-term employment,” said Judy Keagy, a volunteer with the Pima County Interfaith Civic Education Organization.
“The impact amounts to greater barriers, and they have not adequately identified really legitimate exemptions,” she said.
Keagy said there are diseases such as lupus and multiple sclerosis that wax and wane, leading people to be able to work at times, while at other times they cannot. Often those people have jobs, but they are unable to work full time.
“There is a whole culture of trying to reduce costs in ways that are cruel to people,” said Suzanne Mongelli, 23, a recent graduate of the University of Arizona.
Mongelli has chronic pain and has been on AHCCCS for three years.
She attended the forum to speak out against the proposed changes, which she considers immoral, she said.
“People with chronic illnesses might be labeled able-bodied,” she said.
25% of Arizonans
AHCCCS is a $12 billion program that currently enrolls more than a quarter of Arizona’s population, or 1.9 million people, including 288,912 residents of Pima County, the agency’s January enrollment numbers show.
The current potentially affected population with enrollment of more than five years is about 242,000 people, an AHCCCS analysis found. That number could be inaccurate because AHCCCS does not collect some data that could affect the total, including the number of enrollees who are employed full time.
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 the state legislation says AHCCCS must reapply by March 30 each year for proposals in SB 1092 that have not been approved or are not in effect.
