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Bill limiting Medicaid to 5 years sent to Gov. Jan Brewer

PHOENIX — A proposal that could force able-bodied Medicaid recipients to
get a job and limit some to a maximum of 5 years of insurance is on its way to
Gov. Jan Brewer for consideration after the House gave final approval to
Republican House Speaker Andy Tobin’s bill on Thursday.

House Bill 2367 requires the state’s Medicaid program to apply for a waiver
from federal regulators every year to allow it to impose the new rules. Federal
officials at the Centers for Medicare and Medicaid Services reiterated Thursday
that the work-rule and time-limit proposals may not be approved because they
likely run counter to Medicaid’s laws and regulations. Tobin, however, has said
he believes Medicaid’s position could change.

Tobin’s bill also imposes copays on unneeded ambulance and emergency room use.
He has said the rules are needed to protect the state from excess expenses.
Democrats argue they would limit the effectiveness of the health system for poor

The bill passed both the Senate and the House on party-line votes, with
majority Republicans in support and Democrats opposed.

There was little discussion during the final vote Thursday.

As originally introduced in February, the bill would have a hard limit of five
years for anyone getting Medicaid. After an outcry from Democrats over its
effect on the working poor, Tobin changed that provision and it now only affects
people who are able-bodied and don’t work. He also added exemptions for pregnant
women, those on disability and those caring for young children.

Budget analysts estimate that more than 140,000 current Medicaid recipients
would lose coverage.

Tobin, R-Paulden, said the federal opposition could change and the requirements
give the state tools to cut enrollment if the government fails to fund the
program as promised.

“Clearly, these dollars are going to end up on the backs of the states,” he
said last month. “All we’re doing is saying let’s request every year the
opportunity for some of these waivers.”

Tobin’s proposal also includes a requirement for a copay for unnecessary visits
to hospital emergency rooms or ambulance use. The federal government had been
allowing Arizona to charge $30 copays for unnecessary emergency room visits, but
that expired Dec. 31. Arizona is now asking federal officials for authority to
charge $200 for such visits for newly eligible people on the state’s Medicaid
plan, called the Arizona Health Care Cost Containment System, or AHCCCS.

Rep. Eric Meyer, D-Paradise Valley, said Tobin was trying to limit the reach of
the program and eventually remove them from eligibility. A Medicaid-expansion
proposal pushed by Gov. Jan Brewer last year led to a fracture among fellow
Republicans and an impasse she finally broke by calling a special legislative

An analysis of the bill’s impact released Wednesday by the Legislature’s budget
analysts estimated that 141,000 current Medicaid recipients would lose coverage
under Tobin’s lifetime limit. That could save the state nearly $150 million a
year. Only about half of the 440,000 able-bodied adults now getting insurance
meet the work requirement. A total of more than 1.4 million Arizonans were
enrolled in the state’s health insurance plan for the poor as of April 1.


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