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Judge upholds state Medicaid cuts


A Maricopa County Superior Court judge upheld a partial enrollment freeze for the Arizona Health Care Cost Containment System, rejecting a liberal advocacy group’s claims that the cuts violated a voter mandate.

Judge Mark Brain today ruled that Proposition 204, a 2000 ballot measure that dramatically expanded AHCCCS eligibility, does not require the Legislature to provide additional funding for Arizona’s Medicaid program, or violate the Voter Protection Act.

Brain also said Prop. 204 does not require AHCCCS Director Tom Betlach to provide the coverage that the Arizona Center for Law in the Public Interest sought to restore.

“The Legislature does not have an enforceable duty to fund Proposition 204, and the scope (and limit) of defendant Betlach’s duty is to continue to ensure that his agency is providing health care to the extent possible under Proposition 204 within the limits of the funding provided to him,” Brain wrote in his ruling.

The ruling leaves intact the budget approved in April by the Republican-controlled Legislature and Gov. Jan Brewer. The enrollment freeze is expected to trim about 100,000 patients from the AHCCCS rolls in fiscal year 2012, which is estimated the save the state about $207 million.

“I applaud the Superior Court today for its ruling regarding the State of Arizona’s Medicaid Reform Plan. This ruling ensures that elected officials maintain their authority to make difficult financial decisions on behalf of the State of Arizona,” Brewer said in a press release. “I don’t take lightly the Medicaid reforms we’ve implemented. The human impacts are real. But I and members of the Legislature were elected to make difficult decisions.”

The Arizona Center for Law in the Public Interest sought an injunction against the enrollment freeze for childless adults, which went into effect on July 8. ACLPI Attorney Anne Ronan said the center will appeal the ruling.

“If this is the law of the land then voter initiatives really don’t have much impact,” Ronan said.

Brain rejected the center’s arguments that Prop. 204 and the Voter Protection Act required the state to use whatever funds necessary to fund AHCCCS. Prop. 204 expanded Medicaid coverage to include all childless adults who earn up to 100 percent of the federal poverty level, which was funded through a court settlement with tobacco companies and other “available” funds.

The judge did not address the long-running dispute over whether the available funds provision required the Legislature to use whatever means necessary to fully fund the Prop. 204 population. Instead, Brain ruled that the voter mandate could not force the Legislature to appropriate funding for Medicaid.

The Voter Protection Act may prohibit the Legislature and governor from repeal or amending voter initiatives, Brain wrote, but “it does not require the Legislature to do anything.”

“This is not a self-executing provision. Proposition 204 enacted statutes but did not amend the Constitution, and the Voter Protection Act does not impose an enforceable duty on the Legislature to fund Proposition 204,” Brain wrote. “Simply put, the court lacks the authority to make the Legislature fund Proposition 204.”

Democrats lambasted Brain and his ruling, which many described as both devastating for low-income Arizonans who rely on AHCCCS for health care and a violation of voter mandate.

Sen. Kyrsten Sinema, D-Phoenix, said the language in Proposition 204 is clear that the Legislature has no say over whether to fund Medicaid coverage for childless adults. She called Brain’s ruling an “incredibly unusual interpretation.”

“When a judge makes a determination about the statute, the first thing the judge is supposed to look at is the plain language of the statute,” Sinema said. “If that interpretation were accurate, then the Legislature wouldn’t’ have to implement any of the laws passed by voters.”

House Minority Leader Chad Campbell said the AHCCCS cuts violated the will of the voters. He also noted that Prop. 204 prohibited the state from capping the number of AHCCCS patients or cutting people from the rolls.

“I think it was very obvious what the voters were choosing to vote on when they went to the polls,” said Campbell, D-Phoenix. “It’s just a bad decision all around.”

Brain’s ruling was the second this year that rejected voters’ ability to force the Legislature to make appropriations. Maricopa County Superior Court Judge Kenneth Mangum in February ruled that Proposition 301, a 2000 ballot measure that required the state to increase K-12 funding each year to compensate for inflation, didn’t actually require the Legislature to make any appropriations because that authority rests solely with the Legislature.

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