PHOENIX – Rebuffed last year in his bid to impose a work requirement on Medicaid recipients, Gov. Doug Ducey is trying again.
But the new proposal, to be submitted later this month, will be scaled back from what federal officials rejected before. Now the governor is offering new exceptions and even a limit on how much time someone needs to spend on a job or in training each week to keep benefits.
And Christina Corieri, the governor's health adviser, said something else is different: The people who will review the plan in Washington. She said 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.
Corieri said Arizona will once again ask to put a five-year lifetime limit on benefits, something the state is required to do under the terms of a 2015 law. But she acknowledged that is likely to meet the same fate as a similar proposal in last year's bid.
Even with that, she figures that just 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.
It was Ducey who signed the 2015 legislation that requires the state to annually seek permission to impose work requirements on Medicaid recipients and 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 who had vetoed nearly identical legislation a year earlier. Jan 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 up to 138 percent of the federal poverty level. That's currently about $28,180 for a family of three.
Current law does not allow states to impose additional requirements. But CMS does permit states to seek waivers if they can show a good reason.
That's what's Arizona is trying to do here.
The key is in that work requirement for anyone at least 19 years old. That's the same proposal as was rejected last year.
But she said the proposal being submitted has some 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 six 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 that the requirement to work could be fulfilled by someone in schools, including community colleges and universities as well as pursuing a GED or taking courses in English as a second language.
And to sweeten the package in hopes of getting CMS she said that the work requirement would be considered met if an individual were engaged in any of these activities for at least 20 hours a week.
There are even exceptions to that.
“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 CMS, AHCCCS Director Tom Betlach promoted the proposal as not only financially and economically sound but also in 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.