Who is eligible
Children 0-1 with family income up to 147% of FPL; age 1-5 with income up to 141% of FPL; 6-18 with income up to 133% of FPL; pregnant women with family income up to 156% of FPL; parents with family income up to 133% of FPL; childless, non-elderly adults with family income up to 133% of FPL; elderly and disabled individuals who have special requirements and meet certain income limits.
- healthinsurance.org contributor
- September 26, 2016
The outlook for Arizona’s uninsured has improved significantly through the Affordable Care Act. According to a 2014 Kaiser Family Foundation report, 22 percent of the state’s uninsured residents qualify for subsidies to purchase insurance through the marketplace. And, given Arizona’s decision to expand Medicaid, 41 percent of uninsured residents qualify for Medicaid. But Governor Ducey wants CMS to approve a waiver that would add various eligibility restrictions to the Medicaid program.
Who qualifies for AHCCS?
Arizona has taken a somewhat unique approach to income limitations for covered Medicaid populations. While many states cover children at much higher income level than adults, Arizona has established income limits that are relatively consistent across covered groups.
The Medicaid program in Arizona is called the Arizona Health Care Cost Containment System (AHCCCS, which is pronounced “access”). AHCCCS is available to:
- Children birth to 1 year with family income up to 147 percent of the federal poverty level (FPL)
- Children 1 to 5 years with family income up to 141 percent of FPL
- Children 6 to 18 with family income up to 133 percent of FPL
- As of July 2016, children not eligible for Medicaid but with family income up to 200 percent of FPL are eligible for KidsCare (CHIP)
- Pregnant women with family income up to 156 percent of FPL
- Parents with family income up to 133 percent of FPL
- Childless, non-elderly adults with family income up to 133 percent of FPL (Medicaid expansion population)
- Elderly and disabled individuals who have special requirements and meet certain income limits
Arizona froze enrollment in KidsCare—its version of the Children’s Health Insurance Program— in 2010, and discontinued KidsCare at the end of January 2014 due to lack of funding. For more than two years, Arizona was the only state that didn’t have CHIP. But in July 2016, CMS approved Arizona’s proposal to re-open CHIP. Enrollment began July 26, and coverage will take effect as early as September 1, 2016. The state expects 30,000 to 40,000 children to be newly-eligible for CHIP.
To check if you qualify for AHCCS, you can use the Quick Screener on the Health-e-Arizona Plus website. The site houses the on-line application for medical, food/nutrition, and cash assistance programs, and it connects with the federal health insurance marketplace, HealthCare.gov.
How to apply for Medicaid
The quickest way to apply for AHCCS is online at www.healthearizonaplus.gov.
Or you can enroll through healthcare.gov.
If you need help completing an application, call 1-855-HEA-PLUS (1-855-432-7587) or search online for a community assistor.
Challenge to Medicaid expansion
Former Gov. Jan Brewer pushed for Medicaid expansion for Arizona, and it was approved by the state legislature. However, a conservative organization and 36 state Republican lawmakers challenged the legislative process related to Medicaid expansion. The case was dismissed, and the dismissal was appealed to the Arizona Supreme Court. The court ruled in December 2014 that the challenge could proceed.
In a victory for Medicaid expansion advocates, a judge ruled in May 2015 that patients with Arizona Medicaid coverage would be allowed to take part in the lawsuit in defense of Medicaid expansion. The lawmakers who brought the suit had argued that patients shouldn’t have a voice in the case. And in August 2015, a Maricopa County Superior Court Judge sided with Medicaid expansion advocates, ruling that the hospital fee to fund Medicaid expansion is an assessment, rather than a tax (the latter would have required a supermajority in the Arizona House and Sentate).
Brewer did not run for re-election in 2014 due to a term limit, and new Gov. Doug Ducey, a Republican, prominently featured his opposition to the Affordable Care Act in campaign literature. He appointed Christina Corieri as his policy advisor for health and human services issues. Immediately prior to her appointment, Corieri was with the Goldwater Institute, which is the organization that filed the challenge against Medicaid expansion.
In the 2015 legislative session, Arizona lawmakers passed Senate Bill 1092, which makes an effort – at least symbolically – to dial back the state’s expansion of Medicaid. SB1092 requires the state to submit a waiver request to CMS every year, asking for approval for new Medicaid eligibility guidelines. The new eligibility rules would include a five year limit on Medicaid coverage for able-bodied adults, along with a provision requiring enrollees to be working or involved in job training or school. It’s unlikely that CMS will approve of such a waiver, but Arizona submitted their first waiver proposal in October 2015.
In August 2015, Ducey unveiled his proposals for Arizona’s first Medicaid waiver proposal, including the five year lifetime limit on Medicaid coverage for able-bodied adults. Ducey’s waiver proposal also includes a requirement that enrollees pay increased premiums and cost sharing and establish health savings accounts, and participate in various wellness programs like flu shots and glucose screening. In order to be able to access their health savings accounts, able-bodied adults would either have to be working, in school, or actively involved in a job search or job training program. The idea is that Medicaid would remain a solid safety net for children and disabled adults, but that it would become a more temporary program for able-bodied adults, while helping them eventually increase their income enough to transition off the program.
There is widespread support for the idea of modernizing AHCCCS, but many advocates for low-income Arizona residents are worried that Ducey’s proposal will simply serve to as a setback, chipping away at the hard-won gains the state has made in reducing the uninsured rate from 20.4 percent in 2013 to 14.5 percent in the first half of 2015.
With Medicaid in Arizona currently covering non-elderly adults, about 40 percent of Arizona’s uninsured residents (in 2013) qualify for the program according to the Kaiser Family Foundation. From late 2013 to April 2016, total enrollment in Arizona’s Medicaid program grew by 466,260 people – a 39 percent increase. But there is no doubt that if CMS were to approve Ducey’s proposal to cap Medicaid benefits at five years, the result would be fewer people eligible for Medicaid coverage.
Arizona’s Medicaid program has operated for more than 25 years under a Section 1115 waiver that allows the state to use capitated managed care. In December 2014, CMS approved a new 1115 waiver for Arizona’s Medicaid program, although they declined to approve some aspects of the proposal, including a proposed $200 fee for non-emergency use of an emergency room for Medicaid enrollees with income above the poverty level.
The state’s previously approved 1115 waiver is set to expire in September 2016. The state is continuing to work with CMS to come to an agreement on a new waiver, and in July 2016, Arizona published a revised version of their proposed Medicaid modernization waiver.
History of Medicaid in Arizona
Arizona was the last state to implement a Medicaid program, establishing AHCCCS in October 1982.
Medicaid expansion under the Affordable Care Act was signed into law in Arizona in July 2013. Arizona was one of the first states led by a Republican governor to sign on to expansion.
More than 88 percent of Arizona’s Medicaid beneficiaries receive services through managed care arrangements. Medicaid managed care helps states provide access to health care providers, improve quality of care, and control financial risk.