Gov. Doug Ducey’s Medicaid plan calls for lifetime limits, copays
- Ducey unveils a plan to step up efforts to reduce the state’s Medicaid enrollment numbers
- The AHCCCS CARE program affects able-bodied adults, but not children or the elderly
- It proposes copays, work requirements, 5-year lifetime limit
Gov. Doug Ducey’s plan to modernize Arizona’s Medicaid program has numerous details yet to be worked out. And much of it hinges on approval from the federal Centers for Medicare and Medicaid Services.
Its intent is clear: Require the estimated 350,000 able-bodied adults on AHCCCS to take more responsibility for their health coverage through copays and incentives to find work. The idea is to promote healthy, employable people and move them out of the Arizona Health Care Cost Containment System before a five-year lifetime limit would cut them off for good.
Critics say the governor is trying to fix something that isn’t broken. Sam Richard, executive director of Protecting Arizona’s Family Coalition, suggested the energy would be better spent reforming the state’s prison system, rather than making it harder for poor people to become independent.
On Monday, Ducey’s office held a briefing after formally unveiling the program. The following are questions and answers drawn from that briefing.
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Why is the governor doing this?
With the state’s Medicaid program, AHCCCS, up for renewal next year, this is a good time to introduce changes.
What are the key changes that would affect the able-bodied adults the governor is targeting?
To qualify for what would be called the AHCCCS CARE program, these adults would have to:
- Make copayments of up to 3 percent of their household income for certain services the state wants to discourage, such as an emergency-room visit when a doctor appointment would suffice.
- Pay another 2 percent of their income into a health-savings account that could be tapped for health services AHCCCS doesn’t cover, such as dental or vision care.
- Be actively looking for work and use programs designed to help people find jobs, such as resume writing.
- Meet certain health goals, such as getting a wellness exam or an annual flu shot.
What if I don’t have the money to make the payments?
If your income is above the federal poverty limit ($11,770 for a single person; $24,250 for a family of four), you would be dropped from the program for six months.
If your income falls below that limit, the money would be considered a debt to the state, potentially collected through the Department of Revenue.
What if I find work, but my salary is low enough to still qualify for AHCCCS?
You could stay in the AHCCCS CARE program.
What if I can’t find work?
If you meet the able-bodied adult definition, you could no longer use the AHCCCS program after a total of five years of coverage.
What is this health-savings account all about?
It’s intended to help build a “personal safety net” that an person can use for services not covered by AHCCCS. If someone gets a job and moves off AHCCCS, the money in the account goes with the individual and can be used for other health-related expenses.
Who is NOT affected by this?
Children, the elderly, single parents caring for children age 6 or younger, the seriously mentally ill, those on disability and pregnant women. Of the 1.7 million Arizonans currently on AHCCCS, this would affect up to 350,000 people, or less than 25 percent.
Would doctors and hospitals have to collect the copays?
No. AHCCCS would be responsible for this. There should be no change to what health-care providers do.
How much money would this save the state?
Ducey’s staff says it has not calculated the amount yet.
What are the chances of this happening?
Much of it will depend on federal approval. The federal government has never approved a lifetime limit on health coverage. But Ducey’s staff say other elements of the plan, such as small copays, have been approved in other states’ plans.
Other aspects, such as development of a smartphone app to help AHCCCS clients stay on top of their health issues, will happen next year, regardless of what the federal government does.
How do I learn more?
There is a fact sheet online here.
AHCCCS will be hosting community forums, starting with two in Phoenix on Aug. 18. Details are here.
Reach the reporter at maryjo.pitzl@arizonarepublic.com or at 602-444-8963.