PHOENIX - Gov. Jan Brewer on Thursday signed legislation she negotiated to balance the state budget, cut aid to public schools and universities and pave the way for slashing the number of people getting free health care.
But it does reinstate state coverage for certain transplants for the needy.
The $8.3 billion spending plan includes about $1 billion in cuts to make up for the sharp decline in tax collections since the recession. More than half of that comes from reductions in funding for the Arizona Health Care Cost Containment System.
Officially, lawmakers do not spell out how that will happen. Instead, they are relying on plans by the governor to stop enrolling childless adults in the program - something not required under federal Medicaid rules - as well as some parents whose income is above federal standards. It also is built on a series of new fees and co-pays.
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But the entire plan could unravel.
Part of the problem is that Brewer wants to start making enrollment changes July 1. That requires approval from the U.S. Department of Health and Human Services, as do her requests for the new charges.
The bigger hurdle, however, is that her plan to scale back eligibility is likely to wind up in court.
Attorney Tim Hogan of the Center for Law in the Public Interest said he is readying a lawsuit challenging the move. He said a 2000 voter-approved initiative requires the state to provide free care for everyone below the federal poverty level, about $18,300 a year for a family of three. Brewer's plan eventually could eliminate up to 160,000 people out of the estimated 1.3 million enrolled in AHCCCS, people whom that 2000 law made eligible.
Brewer and Republican legislative leaders counter that the 2000 law requires the state to fund expanded enrollment only to the extent that funds are available. She said the state's budget situation proves there is no spare money.
In a letter to legislators, Brewer said the changes were necessary. She said AHCCCS consumed 17 percent of the state budget four years ago; now it is 29 percent.
But even as the plan slashes eligibility, it includes language directing AHCCCS to find the funds to once again provide coverage for nearly 100 people who are enrolled in the program and were scheduled for transplants before lawmakers voted last year to stop funding them. While there is no specific appropriation in the budget, the cost has been estimated at $1.2 million.