Health care

Putting a work requirement and lifetime limit on people receiving Medicaid will deny health care to some of Arizona's poorest residents, a Tucson crowd told state officials this morning.

The proposals were rejected once by the federal government, but Arizona is re-submitting them and seeking public input. Medicaid is a government insurance program for low-income people.

"There's never been a waiver 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 (presidential) administration."

Cost shift

The reaction from those who attended a public hearing on the proposed changes, held today held at Banner-University Medical Center South, was overwhelmingly negative. AHCCCS hosted the two-hour hearing, which drew about 90 people.

Among populations that could be shut out of health care are adults who are caregivers for disabled children or elderly relatives; people with felonies who have trouble finding jobs; and people living in rural areas, state officials were told.

Kicking people off of Medicaid because of the lifetime limit or work requirement will result in more uninsured people seeking care in emergency departments, the critics 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."

SB 1092

Arizona must re-apply to the Centers for Medicare and Medicaid Services to make the changes by March 30.

The proposed changes were spelled out in a state law — Senate Bill 1092 — that passed in 2015. Among those changes is putting a five-year limit on enrollment for "able-bodied" Arizonans, and also imposing a requirement that would able-bodied people enrolled in AHCCCS be employed, looking for work, in school or in job training.

The legislation 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.

"Able-bodied" is broadly defined as anyone over the age of 19 who is mentally and physically capable of working. There are exceptions, including anyone over the age of 19 who is still in high school; sole caregivers of children under age 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.

Crow and others at the Tucson forum said the changes are short-sighted 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.

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Keagy and others 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.

"There is a whole culture of trying to reduce costs in ways that are cruel to people," said Suzanne Mongelli, a 23-year-old recent graduate of the University of Arizona.

Mongelli has chronic pain and has been on AHCCCS for three years. She attended today's forum to speak out against the proposed changes, which she considers immoral, she said.

"I have a supportive family and that is not the case for many others," she said. "People with chronic illnesses might be labeled 'able-bodied.'"

AHCCCS 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.

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 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.

The public is also invited to review and comment on the waiver proposal via email to publicinput@azahcccs.gov or by mail to: AHCCCS, c/o Office of Intergovernmental Relations, 801 E. Jefferson St., Mail Drop 4200, Phoenix, AZ 85034.

All comments received by Feb. 28, 2017, will be reviewed, considered and included in the final proposal sent to the Centers for Medicare & Medicaid Services, state officials say.

Contact health reporter Stephanie Innes at sinnes@tucson.com

Twitter: @stephanieinnes