Unable to block expansion of Medicaid in Arizona, Republican legislators are now seeking to impose new restrictions on who can get care, and for how long.
Legislation approved Thursday by the House Committee on Reform and Human Services would require the director of the Arizona Health Care Cost Containment System to seek federal permission to require those in the program who can work to be employed, looking for work or be in a job-training program.
HB 2367 also seeks to impose “meaningful copayments” on those who use emergency rooms or ambulance services who do not have true emergencies.
But the most significant part of the legislation seeks an absolute lifetime limit of five years on care for all able-bodied adults. House Speaker Andy Tobin, sponsor of the measure, said that cap is justified.
“My fear is that we are putting people in situations where they never have to leave the home, and have their welfare checks show up even though they're able bodied, have their health care covered even though they're able bodied, and not go out and work when they're able,” he said.
The measure is crafted so that five-year limit applies even if the person actually is working but is simply in a job which pays so little as to make him or her eligible for Medicaid.
That clearly is possible.
The law sets eligibility at 138 percent of the federal poverty level. For a family of three, that is $26,951 a year. That translates to $12.96 an hour for a single parent in a full-time job.
Tobin said he stands by the limit.
“You have five years of the taxpayer paying your health care,” he said.
That same committee also voted along party-lines to actually repeal the expansion of Medicaid approved just last year and the assessment on hospitals to pay the state's share.
That vote on HB 2324 , however, is far from a surprise: A majority of the Republicans who control both the House and Senate opposed the expansion. It also is likely to prove largely meaningless.
Gov. Jan Brewer got expansion approved last year by cobbling together a coalition that included all the Democrats with a handful of Republicans, and there is no reason to believe that any of the supporters have changed their minds, meaning it is virtually certain to fail when it reaches the House floor.
Even if it somehow squeaks through, Brewer has indicated she will veto the plan. And there clearly is not the two-third margin for a veto override.
With outright repeal essentially off the table, that leaves the restrictions being pushed by Tobin.
The Paulden Republican said he's interested in preventing fraud. He noted one of the things he wants is a requirement for Medicaid recipients to verify their income monthly and report any changes, with those who do not comply losing eligibility for a year.
But Tobin also said he wants limits, including that five-year cap. That concerned Rep. Sally Gonzales, D-Tucson who questioned what happens for those who cannot find work.
“Right now we don't have enough jobs for the people who are looking for jobs,” she said.
Tobin said the idea of a cap is not unique. For example, there is a similar five-year lifetime benefit for the cash assistance program.
He also cited the 26-week limit on unemployment benefit, at least those paid through a tax on state employers, though the federal government has provided extended benefits. But that is not a lifetime cap, with someone who gets a new job eligible for new benefits once they have worked a certain period of time.
Left unclear is whether Medicaid officials would approve the requested changes. Their OK is necessary because Washington provides two-thirds of the money to run the state program.
There is no evidence that Medicaid ever has approved a lifetime cap, and Monica Coury, an assistant director of AHCCCS, said if the legislation is approved her agency will seek “guidance” from Medicaid officials.
Copays are a different issue.
Medicaid has previously allowed the state to impose charges for childless adults who are not required to be covered by federal law.
Coury said those copays, including $30 for non-emergency use of the emergency room, expired at the end of last year. She said Arizona now is seeking a $200 copay for childless adults, but only those whose income is higher than the federal poverty level but below the 138 percent cap.
Christina Corieri who lobbies for the Goldwater Institute said it does not matter if the Obama administration has rejected requests for waivers of federal rules from states.
“As we know, administrations change, and the feelings in Washington change,” she said.