PHOENIX — About 126,000 Arizonans who get free health care will soon be required to work if they can.
The federal Center for Medicare and Medicaid Services on Jan. 25 approved the state’s request that it be allowed to add a “community engagement” requirement to some enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid program. That means 80 hours a month of work, job search, part-time schooling, job training or organized community service, all of which has to be documented by the 10th day of the following month.
Those who don't comply will find their benefits suspended for two months.
The announcement culminates multi-year efforts by Gov. Doug Ducey who, since the first days of his administration, has sought to make work a condition of the program.
But it is far scaled back from what the governor originally sought.
There are a host of exceptions, ranging from people with disabilities and those attending school on a full-time basis to women who are pregnant or have given birth in the past 60 days. And members of federally recognized Native American tribes also need not comply.
It also applies only to those age 19 through 49.
The state can’t begin enforcing the requirement until at least next January.
And there’s something else.
The mandate approved by CMS — federal OK was required since it pays the lion’s share of the cost of Medicaid — applies only to those whose income is above the federal poverty level, which is $20,780 for a family of three. AHCCCS provides coverage for those earning up to 138 percent of the poverty level, or $28,676 for that same family of three.
AHCCCS figures that’s about 126,000 out of nearly 1.9 million Arizonans who get at least some care through the program.
In general, states cannot impose their own requirements on Medicaid recipients beyond what is permitted by federal law. But CMS does allow states to seek waivers if they can show good reason.
But Congressman Raul Grijalva (D-Ariz.) said what CMS did here is a “stretch of the law.”
“Congress never intended waivers to kick people out of the Medicaid program, and the law explicitly prohibits that,” he said in a prepared statement. He predicted the CMS decision will lead to lawsuits.
Even it does not, Grijalva said the decision is bad public policy.
“Our hospitals will once again be flooded with uncompensated care and families struggling with health issues, including women who have recently given birth, will be one medical bill away from bankruptcy,” he said.
But CMS Administrator Seema Verma defended the decision.
“Medicaid demonstrations like this one empower states to provide health coverage to their citizens while allowing the states the flexibility to tailor their approach to their unique populations,” she said in her own statement announcing approval of the Arizona request. And Verma suggested one reason her agency approved the state request was it consulted with tribes, ultimately agreeing not to try to impose the work requirements on tribal members.
Ducey also said the state request — and the federal approval — was a good idea.
“Employment and community engagement are proven to have a positive effect on overall health and well-being,” the governor said. “By aligning educational and employment incentives, and providing robust job-search support services and educational opportunities, Arizona can create pathways toward better health outcomes and employment opportunities for our citizens.”
But Siman Qaasim, director of health policy for the Children’s Action Alliance, said it’s not that simple. She said it’s easy for people to be tripped up by new paperwork requirements.
The real problem, she said, is it fails to recognize the kind of things that will disqualify people.
For example, Qaasim said, it’s fine to say that people should be working 20 hours a week.
“It just doesn't happen in real life,” she said, with people working certain jobs getting to come in only when they're assigned a shift.
“They want to work,” Qassim said.
And she said people who get sick and don’t meet the work requirements for that month then find themselves in the position where they have neither work nor health care. Qassim said it’s fine to say people can seek a waiver.
“But it’s hard to navigate the bureaucracy to get an exemption while lying in the hospital with a broken arm.”
AHCCCS spokeswoman Heidi Capriotti said one concession to the problems people may have is that those who don’t meet the work requirements lose their coverage for only two months, at which point they automatically are reenrolled. In the other states that have been allowed to impose similar requirements, those who fail to comply are kicked out of the system entirely.
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