U.S. Reps. Raul Grijalva and Ed Pastor have gone on the offensive against Gov. Jan Brewer’s plans to freeze Medicaid enrollment.
In a May 4 letter, the Democratic congressmen urged Cindy Mann, director of the Centers for Medicare and Medicaid Services (CMS), to reject Brewer’s request for a new agreement with the feds that would allow Arizona to cut about 100,000 people from AHCCCS, the state’s health care system for the poor, in 2012 by halting enrollment for childless adults and some parents.
Grijalva and Pastor argued that the enrollment freeze would violate the maintenance-of-effort provision in the Affordable Care Act, which prohibits states from reducing eligibility for their Medicaid programs. They also decried the impact the plan would have on low-income Arizonans and the state’s economy, and alleged that Brewer’s plan is a “thinly veiled request that will undoubtedly result in the full termination of the program.”
“To slash this vital program in times of economic challenges would be irresponsible as it will further devastate our economy and could create a public health crisis,” the congressmen wrote in their letter. “Thus, it must be made clear that the intent of Congress will be carried out and that the objectives of the Medicaid program will be upheld.”
Brewer and AHCCCS officials have said repeatedly that they do not want to see the system dismantled, though there have been some legislative attempts to do so.
The letter laid out a point-by-point rejection of Brewer’s AHCCCS plan, including an enrollment freeze for childless adults and parents earning more than 75 percent of the federal poverty level; mandatory co-payments; fees for missed appointments; the elimination of non-emergency medical transportation; and the elimination of reimbursements to health care providers for treating illegal immigrants. The plan is expected to save the state about $500 million.
“Freezing Arizonans out of the state health care system doesn’t magically reduce costs – it just passes the buck and ensures that working families don’t get the care they need,” Grijalva said in a press release. “There’s no reason for CMS to allow it to go forward and I hope for our state’s sake that they make the right decision.”
The congressmen also argued that the Arizona Competitiveness Package, a massive tax cuts and incentives package the Legislature passed in February, will be paid for on the backs of AHCCCS patients who will lose coverage. However, most of the package’s provisions don’t kick in until 2015, and the tax cuts don’t phase fully in until 2018.
In January, Brewer applied to the U.S. Department of Health and Human Services for a waiver from the Affordable Care Act’s maintenance-of-effort provision in order to allow the state to cut about 280,000 patients from AHCCCS. HHS Secretary Kathleen Sebelius later announced that Arizona could make the cuts without federal approval because its demonstration waiver – the agreement under which the state and federal governments jointly fund Arizona’s Medicaid program – expires in October.
But Arizona must still get a new waiver approved to continue funding the portions of AHCCCS that Brewer plans to leave in place. CMS recently approved the first portion of Brewer’s plan – the elimination of coverage for people who qualify for Medicaid because of major medical bills, known as the “spend-down population.” AHCCCS is still waiting for approval for the enrollment freeze for childless adults, which is scheduled to go into effect on July 1.