Ducey’s Plan to Claw Back Medicaid Benefits while Keeping Federal $
Arizona Governor Doug Ducey recently met with Trump to discuss the ACA repeal and its effect on Medicaid expansion money for the state. At first, I was hopeful that Ducey would try to prevent vulnerable Arizona residents from losing their care. Instead, it seems he was there to figure out how to keep the money while getting leeway to throw adults (newly covered under the ACA) back off Medicaid.
His plan: A vague 20-hour-per-week work requirement for “able-bodied” adults, a five-year lifetime aid limit, and mandatory contributions to a Health Savings Account (HSA). The “work” requirement does allow for people to be actively seeking work or enrolled in job training for the 20 hours. However, it does not specify how people will prove they are seeking work or how self-employed small business people and independent contractors will prove they are meeting the work requirement. It also doesn’t seem to make allowances for variations in job hours due to seasonal fluctuations or other factors.
Further, the people who are exempt because they are not “able-bodied” are defined mainly as those who are “currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government” or who are “determined to be physically or mentally unfit for employment by a health care professional in accordance with rules adopted by the administration.”
I called AHCCCS to ask for a copy of the rules adopted by the administration so I could read them. I was informed they have not yet been written.
Once written, the new rules could hurt people like me who were unable to afford expensive private short-term disability policies but are not yet permanently disabled enough to qualify for Social Security Disability. Right now, however, there is no clarity regarding exactly how we would prove we are too sick to work.
If the work requirement does not get people off the rolls, Ducey will dump them at the end of a 5-year lifetime limit–sooner if they fail to contribute a yet-to-be determined amount to an HSA. Ducey has also discussed requiring Medicaid recipients to pay deductibles and co-pays. This sounds fine in theory, but people earning so little that they qualify for Medicaid often have nothing left at the end of the month. They will be back to deciding if they should pay their bills, get a high interest loan, or lose their healthcare.
Ducey’s website euphemistically refers to his plan as “AHCCCS CARE” saying it “ensures Choice, Accountability, Responsibility and Engagement.” See his sales pitch here: http://azgovernor.gov/governor/news/2015/08/governor-doug-ducey-announces-ahcccs-care-program%20. The Arizona legislature began the groundwork for “CARE” in 2015 by passing SB 1092. This bill created statutory law outlining most of the “CARE” requirements mentioned above and requiring the Arizona state government to petition the federal Medicaid program for a waiver to enact them before March 30th every year. Click here to read A.R.S. 36-2903.09: http://www.azleg.gov/viewdocument/?docName=http://www.azleg.gov/ars/36/02903-09.htm.
Last year, the Obama administration rejected most of the waiver request. This year, if the Medicaid expansion doesn’t disappear entirely, you can bet the Trump administration will grant the entire request and more.
When that happens, people who fail to meet Ducey’s new requirements will be back out in the cold where many were before the ACA came online. The working poor will have to navigate the thin line between meeting the work requirement and earning too much money to qualify for Medicaid. But, most importantly for Ducey, the state will get to keep those Federal dollars. I guess they will use them to cover the cost of enforcing “CARE” instead of actually providing care.
Stand of up for vulnerable Arizona residents and their right to basic health care by voicing your concerns. Unfortunately, AHCCCS will only take public comment through February 28th. You can email them at PublicInput@azahcccs.gov. And it’s never too late to tell Ducey what you think of his plan at http://azgovernor.gov/engage/form/contact-governor-ducey.