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Medicaid work requirements to take effect in fall 2020

(Deposit Photos/Stillfx)

(Deposit Photos/Stillfx)

About 120,000 Arizonans are going to have to prove they’re working, going to school or doing volunteer service to keep getting free health care.

But not just yet.

The Arizona Health Care Cost Containment System, the state’s Medicaid program, has unveiled its plans to implement the work requirements that were finally approved earlier this year by the federal Center for Medicare and Medicaid Services. And the first patients to be forced to prove they meet the qualifications are going to be from Maricopa, Pima and Yuma counties.

But AHCCCS spokeswoman Heidi Capriotti said that, at this point, no one is in danger of losing health care before fall of 2020. That’s because it’s taking longer than anticipated to not just put the rules and procedures in place, including setting up an online portal, but to have them approved by federal officials.

And, in fact, residents of the smallest counties – Apache, Gila, Graham, Greenlee, La Paz and Navajo – probably won’t be affected before 2022. Capriotti said that’s a simple recognition of the fact that it may be harder for rural residents to comply.

“There are less opportunities for employment, less opportunities for community engagement in general, volunteer opportunities, skills-building opportunities,” she said.

“So we just want to be conscientious about what’s available in each county without rolling it out as a blanket expectation,” Capriotti said. “We can be more thoughtful county by county, area by area what their specific needs and support needs might be.”

There are other issues, including the fact that the most urbanized counties are more likely to have accessible transportation and child care.

The program, when finally fully implemented, culminates efforts that began in 2015 when lawmakers approved and Gov. Doug Ducey signed legislation which required the state to seek permission to impose work requirements on Medicaid recipients and kick them out of the health-care program after five years. A Ducey spokesman said that the time the measure will “ensure that we have a responsible Medicaid program that protects taxpayers and provide care to those who need it most.”

But federal officials rejected the plea, concluding the proposal was overly onerous, especially as it would affect those earning less than the federal poverty level. Since then, the state has recrafted the program regularly in a bid to get the necessary approval of the federal government which pays two-thirds the cost of administering AHCCCS.

They finally came up with a winning formula that was approved in January, but one with lots of exceptions and without that five-year limit.

Most notably, it does not affect those below the federal poverty level, about $21,330 for a family of three. Instead it applies only to those who are eligible for care because they are considered the “working poor’,” and only those without children.

That cuts the number of people affected from more than 1.8 million people in the AHCCCS program to just 400,000.

Also exempt is anyone younger than 19 and older than 49. And there are a whole host of other exemptions, including pregnant women up to 60 days after giving birth, members of federally recognized Native American tribes, caregivers who are responsible for an individual with a disability, survivors of domestic violence, the homeless, under active treatment for a substance use disorder and those considered “medically frail.”

Capriotti said what falls into that last category is one of the things still being developed.

She figures that when all is said and done, the work requirement will apply to only about 120,000.

The agency is a little further along in determining how much time someone needs to work in order to keep benefits, with the floor set at 80 hours a month.

But that also means pulling in the minimum wage, which will be $12 an hour beginning next year. That is designed to ensure that someone does not claim self-employment but is not actually bringing in any money.

Also still being fleshed out is what constitutes searching for a job, which is one of the alternatives to work or volunteer efforts. And there is at this point no specific number of college credit hours someone needs to be taking to also claim an exemption.

And those who fail to meet at least one of the requirements?

They would lose health coverage for two months unless they can show there was “good cause,” like a family emergency or natural disaster.

At this point Capriotti said the earliest the program will be implemented, at least in the three counties AHCCCS considers the most urbanized, is summer of 2020. But even then, she said there will be a 90-day grace period for people to come into compliance, meaning it could be a year from now.

Then, a year later, the program will be expanded into what AHCCCS says are the semi-urbanized counties, meaning Cochise, Coconino, Mohave, Pinal, Santa Cruz and Yavapai, with the six least urbanized counties a year after that.

Rep. Nancy Barto, R-Phoenix, the author of the 2015 law to impose work requirements, said in a prepared statement that it will help those affected “transition from government dependence into the workforce,” something she said “will be truly life-changing.” But Barto was miffed it took this long.

“The fact that it will take nearly five years for these work requirements to be fully implemented highlights the massive regulatory bureaucracy that states must navigate in order to enact commonsense policies,” she said.

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