Washington, D.C. – The Center for Medicare and Medicaid (CMS) gave final notice to Arizona Oct. 21 allowing the state government to operate parts of Medicaid under what is known as an 1115 waiver. The newwaiver, coupled with previous CMS decisions, allows Arizona officials to implement changes thatRep. Raúl M. Grijalva fears will increase taxpayer costs, decrease enrollment and cause job losses throughout the state.
In its new decision, CMS granted the state the ability to charge fees for certain items, such as missed appointments or non-emergency medical transportation. CMS denied other portions of the state’s request, including a proposal to require re-enrollment in the program every six months instead of every year and a proposal to eliminate coverage for 60,000 parents with family income between 75 and 100 percent of the federal poverty level.
The CMS move is the latest in a long-running battle over the future of the Arizona Health Care Cost Containment System (AHCCCS), the state Medicaid program. Rep. Grijalva has pushed throughout the past year to block counterproductive AHCCCS cuts and avoid losing jobs, federal funds and health care access for Arizonans. In March, Rep. Grijalva requested that CMS open a 90-day public comment period, hold an impact hearing with concerned entities in the state and conduct an economic assessment prior to any action on the state’s push to modify the program. CMS did not act on his request.
An Arizona State University estimate (available at http://bit.ly/tQXaVi) of an earlier proposal similar to the current AHCCCS cuts found they would cost the state more than 30,000 jobs.Arizona receives almost $2 in federal matching funds for every dollar the state puts into AHCCCS – funding that will disappear if the state continues to shrink the program.
According to the Center on Budget and Policy Priorities, Medicaid funds are much more powerful as economic assistance than tax cuts. As a February analysis explains, “The net result of repealing [Medicaid funds] thus almost certainly would be weaker economic growth and the loss of the thousands of jobs that would have been created by the lost Medicaid spending.”
In July, CMS allowed Arizona to freeze enrollment by childless adults indefinitely, violating the voter-approved Proposition 204 that authorized coverage for the same population. More than 25,000 childless adults below 100 percent of the federal poverty level have already lost AHCCCS coverage since the state’s freeze went into effect July 8 because they missed the re-enrollment deadline. Tens of thousands more are expected to be eliminated in the next year.
Rep. Grijalva has pointed out that the Medicaid cuts’ projected savings for the state are nearly the same amount as the $538 million package of tax cuts the state legislature passed in February, a package that includes a nearly 30 percent corporate income tax cut.
It is unclear how the state expects sick and injured low-income Arizonans to receive treatment. As a newly released report on the state Medicaid program from Families USA (available at http://bit.ly/uHVykY) points out, “The people with heart disease and diabetes who lose Medicaid coverage will still need to fill the same prescriptions, those with cancer will still need treatment, and those with chronic lung disease will still need medication so that they can breathe more easily. [. . .] There is also a cost to other Arizonans, who often end up paying higher premiums to cover a share of the cost of care that is provided to the uninsured.”
AHCCCS is not the only public health care program to be undermined in recent years. In January 2010, Rep. Grijalva questioned the need for a separate freeze in enrollment to the state children’s health insurance program, which is not part of Medicaid. More than 120,000 children now sit on a waiting list hoping for the freeze to be rescinded. Arizona is the only state in the country with such a freeze in place.
“The painful consequences of all these cuts will be felt soon, they will be felt deeply, and they will be felt throughout the state,” Grijalva said. “This isn’t about making health care more efficient, it’s about making it harder for families to affordthe little health care they haveso corporations can pay less in taxes. When the state has lost millions in federal funding, working Arizonans have lost their health care, and the state economy has lost thousands of jobs, we’ll know where to look for a reason. This is a self-inflicted tragedy in the making, and I hope for our sake the state changes course before it’s too late.”