Please ensure Javascript is enabled for purposes of website accessibility

Tag: AHCCCS

What’s the big deal about dental health and pregnancy?

Anna Leah Eisner

In Arizona, a bill that would provide dental coverage to pregnant people enrolled in AHCCCS (Arizona’s Medicaid program), has been proposed again this year. A bill like this has been proposed at the Capitol every year for at least the last 15 years, but has yet to be passed, largely due to state budget politics. Arizona has attempted versions of a maternal dental coverage bill seven times since 2017, and, despite bipartisan support each time, most have died. The furthest any bill of this kind has advanced is an iteration from the 2018 session, which was passed in the Senate but later stalled and was removed from the budget. 

There are several reasons why this bill continues to be endorsed by health care advocates (including the Arizona Medical Association and the American College of Obstetricians and Gynecologists) in nearly every legislative cycle. Dental care is safe throughout pregnancy, and the health benefits of dental care extend far beyond the tooth. Gum disease, such as gingivitis, is a noted risk factor for poor outcomes in pregnancy and beyond. 

During pregnancy, poor maternal dental health is associated with preterm birth, low birth weight, fetal growth restriction, and the life-threatening disease of high blood pressure in pregnancy called preeclampsia. These poor pregnancy outcomes require lengthy hospital stays, procedural deliveries and increased financial burden to our already stressed health care systems. Maternal dental health is also predictive of the dental health of their children, as infants acquire cavity-causing bacteria from their birthing parent. In a preventive sense, caring for the teeth of pregnant people supports the overall goal of having a healthy population. A healthy population means less money spent on health care, and we know that preventive dental care is relatively inexpensive compared with the costs of a medically complicated pregnancy. 

About half of all births in Arizona are funded by AHCCCS, so the state of Arizona already pays for the consequences of poor pregnancy outcomes, from complicated deliveries to NICU stays. Refusing to cover basic preventive dental care during pregnancy is costly, both for an individual who suffers the consequences and the taxpayers. Maternal dental health has been a bipartisan issue for years. It’s time for Arizona to finally approve coverage for dental care in pregnancy and pass HB2958. After all, improving outcomes for mothers and babies can start with something as simple as a (healthy) smile.

Anna Leah Eisner is a fourth-year medical student at the University of Arizona College of Medicine – Phoenix. 

Don’t let biomarker testing law be a missed opportunity for mental health care

Luis Fong

I am what you might call a first responder in mental health — a psychiatric nurse practitioner based in Gilbert, providing care to patients of all ages through a virtual collaborative care model and in-person across Arizona. My goal is simple: I want my patients to get better. I want them to enjoy their lives and enjoy their families.  

But we’re falling short on mental health in our state.  

  • 18% of adults in Arizona have been diagnosed with depression — 9th in the U.S. 
  • Arizona is ranked #50 / 51 in mental health prevalence and access to care.

The traditional “trial-and-error” approach to prescribing mental health medications can result in frustration – as well as wasted time, money, and medication – for clinicians and patients. Less than 40% of patients with depression achieve remission with their first prescribed drug. With each new medication, the chance of remission decreases, while treatment intolerance increases, according to a large study. 

Mental health disorders are complex and challenging to treat, but there is a tool that can help, and Arizona already passed a law to support it. To help treat my patients, I often utilize mental health pharmacogenomic (PGx) panel tests. These biomarker tests require only a simple cheek swab to analyze a patient’s DNA. The results of the test, which only needs to be administered once in a patient’s life, provide genetic insights that help me understand how a patient may metabolize or respond to commonly prescribed psychiatric medications. In my practice, I have seen how this information can allow me to tailor treatment plans, reduce side effects, and avoid the frustrating trial-and-error process that can delay recovery

In 2022, Arizona was one of the first states in the nation to pass legislation (House Bill 2144) requiring Medicaid and commercial insurance plans to cover qualified biomarker tests for a variety of conditions, including mental health. Biomarkers are biological indicators — such as genes, proteins or other molecules — that provide information about a person’s health or response to a treatment.  

House Bill 2144 created a unique opportunity for Arizonans suffering from mental illness by requiring that personalized medicine tools, like mental health PGx panel tests, be made widely available to better treat mental health disorders when they are covered under Medicare coverage determinations. By requiring health insurance carriers to cover this type of biomarker testing, the Arizona Legislature has signaled its intention to improve access to mental health care in the state. Based on AHCCCS’ published medical policy and the experience in my clinical practice, more than two years after the legislation has been in effect, Arizona’s Medicaid Fee for Service Program — AHCCCS and the Medicaid Managed Care health plans that contract with AHCCCS — to provide care to Arizona Medicaid patients are not adequately covering mental health PGx panel tests that clearly should be covered under the law. 

One such example is the GeneSight Psychotropic Test which had its medical billing code listed on AHCCCS’ fee schedule even before the biomarker law went into effect — allowing coverage of the test by the state Medicaid program and managed care programs. After the law went into effect, however, AHCCCS abruptly removed the code without explanation, effectively designating this Medicare-covered, clinically validated, and legally required biomarker test as a non-covered service for Arizona’s Medicaid population. 

Meanwhile, PGx mental health panel testing remains covered by Arizona commercial insurers, creating a disturbing disparity in access for Medicaid patients, who are often among the most vulnerable and most in need of effective mental health care. Adding insult to injury, coverage is already available to our closest neighbors under both Medicaid Fee for Service and commercial health insurance.  

This is troubling for me and for my patients. As mental illness continues to exact a heavy toll on Arizona and the United States, we should be doing all that we can to seek out and increase access to proven solutions. We cannot afford to squander opportunities to improve access and treatment for mental health care while so many Arizonans are desperate for relief. I am looking to state agencies and policymakers for leadership to ensure that health insurers are following the law.  I urge Arizonans to contact the Governor’s Office, AHCCCS, or their state legislator to ask them to support broad access to mental health PGx panel tests that meet the biomarker law’s coverage requirements.    

Luis Fong is a board-certified family psychiatric mental health nurse practitioner at Spero Psychiatry and Counseling, providing comprehensive psychiatric care to people throughout Maricopa County.

2nd lawsuit filed against AHCCCS over autism therapy contract dispute

Key Points:
  • Parents of 11 children filed a class action lawsuit against the state’s Medicaid agency
  • The complaint accuses the agency of unlawfully approving changes to provider networks
  • The dispute impacts children with autism spectrum disorder receiving applied behavioral analysis therapy

Another lawsuit has been filed against the Arizona Health Care Cost Containment System over contract disputes between insurance companies and two autism therapy centers.

Parents of 11 children with autism spectrum disorder filed a class action lawsuit against AHCCCS on Feb. 6, alleging the agency unlawfully approved changes to provider networks for two insurers: Mercy Care and Arizona Complete Health. The complaint follows another lawsuit filed by families and Centria Autism Center on Dec 15 against AHCCCS, Mercy Care and the Department of Economic Security. 

“AHCCCS’ decision to allow these private insurers to place their own profits over the treatment of low-income kids with autism is shocking,” said Tim Nelson, attorney for the 11 families, in a statement. “These companies have never retained enough autism providers for Medicaid beneficiaries, and waiting lists for families with autistic children were already way too long.”

The lawsuits were sparked by Mercy Care and Arizona Complete Health terminating contracts with Centria Autism and Action Behavior Centers, forcing many families to switch providers for their children’s applied behavioral analysis therapy. Centria and ABC allege Mercy Care terminated their contracts after the insurer attempted to reduce reimbursement rates for services without negotiating in good faith.

Arizona Complete Health terminated its contract with ABC around the same time Mercy Care began terminating contracts, though ABC staff allege that Arizona Complete Health terminated the contract without cause. The class action suit also alleges the insurer has not been assisting patients in finding new therapy providers. 

Applied behavioral analysis, known as ABA, is an increasingly popular form of therapy for children on the autism spectrum and is currently covered by the state’s Medicaid system. Parents of children who receive services from Centria and ABC are afraid that moving their children to unfamiliar therapy centers will cause their children to regress. 

Children with autism spectrum disorder are incredibly sensitive to change and parents of children attending Centria told the Arizona Capitol Times in November that their children have experienced regression as a result of disruptions to their ABA therapy. 

In court filings in the first lawsuit, AHCCCS argued that Mercy Care has openings for clinic-based and in-home ABA services for more than 1,000 of its members, more than the number of members losing access to Centria and ABC.

“Plantiffs’ declarations speak of their emotionally charged preferences and the worries they have about changing ABA providers …” attorneys for AHCCCS wrote on Jan. 9. “… the individual Plaintiffs’ concerns and attachment to Centria’s services (even if understandable) do not rise to the level of irreparable injury.” 

However, the class action suit filed on Feb. 6 argues that the parents’ resistance to switching ABA providers is not just about “emotionally charged preferences” but also about logistical issues such as transportation, a lack of providers with openings in rural areas and reduced hours for services. 

Attorneys for AHCCCS said the families and Centria had no dispute with the agency, but with Mercy Care, and a lawsuit against AHCCCS would not “achieve Plaintiffs’ desired outcome” because the agency cannot reinstate the contracts. 

Attorneys for the 11 families represented in the class action suit argue that allowing the insurers to terminate contracts with ABA providers not only violates state and federal law, but it could result in a wave of other insurers terminating contracts with ABA providers in Arizona. 

The contract terminations are set to take effect in March, leaving families little time to find new providers or a new insurer to cover their children’s ABA therapy. Both lawsuits ask the court to temporarily stay the effective dates while the cases play out, but a ruling on those requests has not yet been issued in either case. 

Arizona agencies request millions to fill the gaps left by federal funding cuts

Key Points:
  • State agencies have submitted their budget requests for fiscal year 2027, which begins July 1, 2026
  • Agencies request millions from Arizona’s general fund to address Medicaid and SNAP cuts
  • Governor will provide lawmakers with her proposed budget in January

Budget requests submitted by Arizona’s state agencies are shedding more light on what it will cost the state to conform to federal spending and tax cuts included in President Donald Trump’s “One Big Beautiful Bill.”

Gov. Katie Hobbs and public health advocates have been warning that cuts to Medicaid, the Supplemental Nutrition Assistance Program and other federal programs would impact both the lives of Arizonans and the state budget. Now, state agencies are saying it will cost hundreds of millions of dollars in the next few years to prepare for those changes, which are set to take effect in 2027 and 2028.

According to the Arizona Health Care Cost Containment System, it will cost $71.4 million in fiscal year 2027 to implement the changes to Medicaid required by the One Big Beautiful Bill, known as H.R. 1. $18.78 million of that cost will come from the state’s general fund if AHCCCS’s budget request is included in next year’s budget. 

“H.R. 1 will represent a significant expansion in the cost burden on the state of Arizona and in particular, the state general fund,” the AHCCCS budget request states. “The state will incur significant increases in administrative expenses and will be asked to make tough policy decisions as providers’ revenues decrease while uncompensated care increases.”

Hobbs’ spokesman Christian Slater said the Governor’s Office will not comment on state agency budget requests, but previously told the Arizona Capitol Times that next year’s budget would be challenging “due to the reckless actions of the Trump administration.”

“H.R. 1 slashes funding for critical services Arizonans rely on while overloading the state with bureaucracy and red tape that will cost significant taxpayer dollars,” Slater said in a statement in August.

In addition to the significant cost to AHCCCS, the Department of Economic Security is estimating it will cost $87.7 million from the general fund in FY2027 to adjust eligibility determinations for both Medicaid and SNAP. DES works in tandem with AHCCCS to administer the state’s Medicaid program and is charged with administering SNAP. 

“SNAP and Medicaid program operations will be disrupted and potentially not be possible at all if these costs are not funded with state dollars,” DES’ budget request states.

DES is also requesting $18.2 million in supplemental funding for the current fiscal year, which began July 1. The supplemental will be used to manage increased workloads caused by changes to SNAP’s work requirements and H.R. 1’s provisions that shift payment error costs from the federal government to states. 

AHCCCS’ budget request notes it will need 92 full-time equivalent staff positions in FY2027 to implement the changes, while DES will need 228 full-time equivalent staff positions. AHCCCS is also estimating that an additional $5.3 million, including $1.6 million from the general fund, will be needed in fiscal year 2028, when some of the Medicaid changes will be in effect. 

Other agencies are also requesting general fund dollars to address other federal funding cuts and dwindling Covid recovery dollars in various areas, from foster care and state laboratory services to Clean Air Act compliance and border operations.

The Department of Health Services is asking for around $2 million from the general fund to backfill the loss of federal funds that supported operations at the Arizona State Public Health Laboratory. The laboratory investigates infectious disease outbreaks, conducts newborn illness screenings and tests for communicable diseases in drinking and surface waters, among other services.

ADHS provides laboratory services to cities, counties, school districts and more, but is prohibited by statute from charging for those laboratory services. ADHS’ budget request said the state funding will ensure those services are provided without interruption during a “very unstable federal funding climate.”

The Department of Child Services is asking for $24.6 million in general fund money, in part to address federal changes to eligibility for Title IV-E, a program that provides funds to assist with the cost of foster care maintenance.

The Department of Environmental Quality said in its budget request that it will not be able to meet requirements of the federal Clean Air Act if it does not get $3.9 million from the general fund in FY2027. Funding for grants related to the Clean Air Act were among those cut by H.R. 1.

And the Department of Homeland Security is requesting nearly $800,000 from the general fund annually to fund the Border Coordination Office, which was created by Hobbs in 2023 using American Rescue Plan Act funding. According to ADOHS’s budget request, that funding will run out in September 2026. 

Hobbs’ office will use the requests from state agencies to create her executive budget proposal, which she will give to the Legislature in January to kick off the 2026 budget negotiations. Any request for funding from the agencies must be approved by the Legislature and Hobbs. 

Paul Petersen – a case of political expediency over justice

Eddie Ableser

It’s been almost five years since Paul Petersen, the former Maricopa County assessor, was sentenced and imprisoned by the federal government for violating a federal compact. Now that Petersen concludes his federal term, he faces an additional five years in an Arizona prison. This is a result of the judge giving Petersen consecutive sentencing instead of concurrent, which would have allowed him to serve his federal and state sentences at the same time.

But is this truly about justice?

The details of Petersen’s case have been obscured by sensational media narratives, portraying him as a greedy attorney who profited from vulnerable children and no shortage of political grandstanding from politicians on the right and left.

The narrative from the media and politicians, however, only tells part of the story. As is often the case, the truth is substantially more complicated.

As a former Arizona Democratic state senator, I have seen both sides engage in this behavior, and it is why I feel compelled to speak up about Paul Petersen, a conservative Republican who was previously the elected Maricopa County assessor. 

Petersen’s case has been riddled with lazy narratives that echo negative stereotypes about immigration, adoption and religion.

Many people I speak with are surprised to learn that at the heart of Petersen’s conviction is a violation of an outdated and obscure compact that prohibits children from the Marshall Islands, a former U.S. trust territory, from being adopted in the United States. A violation of an archaic compact — while it may have made sense in a different era — is hardly the sensational media story it was made out to be.

What makes this case even more tragic is the fact that Petersen never intentionally set out to break the law. In fact, he was just one of many attorneys across the country facilitating adoptions from the Marshall Islands. What set Petersen apart? He was a high-profile politician, and that made him an easy target. Former Attorney General Mark Brnovich saw Petersen’s case as an opportunity to score political points and bolster his campaign for the U.S. Senate.

The claim that Petersen defrauded Arizona’s Medicaid system (AHCCCS) is also more complicated than the narrative that has been portrayed. Arizona law doesn’t prohibit non-U.S. citizens from receiving emergency prenatal care. Petersen did help Marshallese women, often in tough circumstances, to navigate a difficult health care system to ensure their pregnancies were healthy. It is also fair to say that this touches on some of the more complicated aspects of the American health care system, but when Petersen was asked to repay the costs incurred by the state, Petersen did so. In fact, he repaid every penny despite not being legally required to. I believe this demonstrates Petersen’s actions were motivated by a desire to help, and that he has taken accountability for his actions.

As of today, despite completing his time in the federal system, Paul Petersen now resides in an Arizona prison miles away from his children. In fact, upon Petersen completing his term, the federal government sent a letter to the Arizona Department of Corrections offering to move Petersen to house arrest, so that he can be with his five young children. Petersen’s family has also appealed to Governor Katie Hobbs to show compassion by honoring this request, especially because Petersen has served his time in the federal system and taken accountability for his actions.

Unfortunately, Governor Hobbs thus far denied the request of the Petersen family. I agree with his family. I believe Paul Petersen is a victim of an archaic federal compact, overzealous prosecution, and complicated societal issues surrounding adoption. Lost in all the sensationalism is that Petersen helped dozens of families navigate the complicated world of adoption. He has served his time, paid a steep price, and the Petersen family deserves compassion.

As a Democrat who served with Governor Hobbs in the Arizona State Senate, I know her to be a compassionate and thoughtful leader. I believe this is a time for courage, for compassion, and for doing what’s right. I urge Governor Hobbs to heed the appeals for compassion and do what is in the best interest of justice. Paul Petersen has paid his price to society and the Petersen family deserves to be reunited.

Eddie Ableser is a former Arizona state senator.

Medicaid cuts would severely impact Arizona’s mental health system

Dr. Margeret Balfour

For decades, Medicaid has been a cornerstone of Arizona’s health care infrastructure, providing coverage to 1.9 million residents, including low-income families, children, seniors and individuals with disabilities. Arizona’s Medicaid program — the Arizona Health Care Cost Containment System (AHCCCS) — is widely recognized as one of the most cost-effective in the nation, with a per-enrollee cost of $7,439, significantly below the national average of $8,621. AHCCCS further reduces costs through innovative models such as the Arizona Long Term Care System (ALTCS), which saves the state over $2 billion annually by providing home and community-based care as an alternative to costly nursing home placement. 

Medicaid is also critical to Arizona’s nationally recognized crisis response system. The 988 crisis line, mobile crisis teams and crisis stabilization facilities deliver timely and effective behavioral health care, reducing unnecessary reliance on emergency departments and law enforcement. Research from Arizona State University has shown that most individuals experiencing behavioral health crises in Arizona access these services rather than higher-cost settings such as hospitals or jails. 

The real-world impact of Medicaid is reflected in the experience of Mary D., a 38-year-old Arizona mother living with diabetes, asthma, COPD, arthritis and depression. Mary was unable to maintain employment due to her mental health challenges until she received treatment from a Medicaid-funded provider. This care enabled her to return to work and address her other medical conditions — preventing the progression of her illnesses and reducing the likelihood of costly emergency department visits and hospitalizations. Without Medicaid, her ability to care for herself and her family would have been severely compromised, and her health outcomes significantly worsened. 

Proposed federal cuts to Medicaid would undermine these essential systems at a time when the need for behavioral health and substance use services remains high. Nearly 40% of non-elderly adults enrolled in Medicaid experience a mental health or substance use disorder. Reductions in Medicaid funding or benefits would disproportionately affect these individuals and increase strain on emergency rooms, inpatient units, and public safety systems. 

In both rural and urban communities, Medicaid ensures access to preventive care, chronic disease management and behavioral health services. These supports not only improve individual health outcomes but also contribute to broader economic and social stability by supporting employment and reducing avoidable health care utilization. 

The effects of the proposed cuts would be immediate and far-reaching. Delayed access to care often leads to more severe illness, greater emergency department use, and higher health care costs. Hospitals and providers — already operating under strained conditions — would face additional pressure, and Arizona’s progress in building an efficient, community-based behavioral health system would be significantly compromised. 

At a time when Arizona is making measurable progress in improving access and outcomes through AHCCCS, it is essential to preserve, not reduce, Medicaid funding. We urge Congress to protect this vital program and ensure that Arizonans continue to receive the timely, effective care they need and deserve. 

Margeret Balfour, MD, PhD, DFAPA, is the president of the Arizona Psychiatric Society.

Preserving health care in Arizona

Nelson Morgan

By a one vote margin (215-214), on May 22, the MAGA Republicans in Congress passed a budget reconciliation bill that delivers to President Trump his most cherished prize: tax cuts for billionaires. To do so they have cut at least $715 billion in health care spending mostly from Medicaid; $300 billion from the Supplemental Nutrition Assistance Programs (SNAP); and, roughly $500 billion from Medicare. This is a morally corrupt and unambiguous attack on the most vulnerable in our nation, and literally trades health and health care for millions of Americans in exchange for tax breaks for a few hundred of the very richest Americans. It is far from “beautiful.” 

Deborah Howard

According to economist and former Secretary of Labor, Robert Reich, should this bill become law, the impact would be that the richest of the richest (the 0.11%) will gain roughly $390,000 a year. Conversely, it would cost about $1,000 a year for those earning less than $17,000 annually. For those earning between $17,000 and $51,000, the cost would be about $700 a year.  

Health care is a basic human right, and even our current insufficient coverage is supported by the progressive tax structure that we have had since the 1930s: the more you earn, the higher your tax rate. Regardless of your position, regardless of the balance in your bank account, the color of your skin, or your zip code, most of us can agree tax cuts for billionaires is not a policy priority. Especially when it comes at the expense of health care for the most vulnerable.

More than two million Arizonans receive health care through Arizona’s Medicaid, the Arizona Health Care Cost Containment System (AHCCCS, pronounced like “access”). AHCCCS is already at work to “cut costs” of the program by instituting additional work requirements, particularly targeting seniors between 54 and 65 years of age. 

The Arizona Mirror recently provided a sobering perspective on this from New Jersey Democratic Congressperson Frank Pallone, the ranking member on the House Energy and Commerce Committee. Referring to the 98% of Georgians eligible for Medicaid who were nonetheless unable to prove that they met the standards, Pallone said, “It’s not that they weren’t eligible, it’s that the state of Georgia put too many barriers in the way of them being able to qualify,” Pallone said. This is where Arizona is now headed: make enrollment so challenging, people who need the services simply give up.    

While it does incorporate many carveouts for vulnerable people, the Georgia experience does suggest that many sick people will end up in emergency rooms at a later stage in their illness than is safe.

You don’t have to be a policy expert to know the outcomes will include: 

  1. An increase in the uninsured. Approximately 550,000 Arizonans might lose Medicaid coverage, especially if the state cannot compensate for reduced federal funding.
  2. Increased patient morbidity. Simply put, people will be sicker than they have to be. When a patient has concerning symptoms, earlier medical care leads to better outcomes. 
  3. Stress on community health care systems. Hospitals and clinics will experience higher uncompensated care costs. 
  4. Economic Loss. For every $1 billion cut, Arizona could lose over 36,000 jobs and $3.7 billion in economic activity. 

All Americans, including all Arizonans, deserve better. Unforced errors in health policy like these will be repaired when our elected representatives prioritize the well being of our neighbors and our communities, instead of focusing on tax breaks for billionaires. 

The problem is not really one of policy differences; it is a difference of values. When we elect representatives who reflect our values, we will see legislation that seeks to provide quality, affordable health care for everyone, especially the most vulnerable, due to either low income or poor health status. 

Unfortunately, that’s not the case currently. In Washington, and here in Arizona, the legislative branches of government seemingly seek only to reduce taxes on the wealthiest Arizonans. As Paul Wellstone noted, “We all do better when we all do better.” And that’s especially true regarding personal and community health.

Deborah Howard served as a Special Assistant at the U.S. Department of Labor and worked at AARP, as well as Blue Shield of California. Howard is a candidate for the Arizona House of Representatives, LD27.

Nelson Morgan is a retired University of California at Berkeley faculty member and research scientist, and is the former director of the International Computer Science Institute. He is the author of “We Can Fix It: How to Disrupt the Impact of Big Money on Politics”, with a foreword by George Lakoff. 

Hobbs, hospital officials oppose proposed Medicaid cuts by Congress

Key Points:
  • 25% of Medicaid recipients in Arizona could lose coverage
  • Rural areas would be hard hit
  • State favors work requirement with exceptions

Democratic Gov. Katie Hobbs brought nearly a dozen hospital officials to the Capitol on May 29 as part of a public relations effort to stop cuts to Medicaid approved by the Republican-controlled U.S. House.

The executive and others each predicted dire results if the measure is approved in the current form by the Senate and, ultimately, signed by President Trump. These included layoffs and possible closure of some rural facilities.

And Hobbs predicted that up to a quarter of the nearly 2 million Arizonans currently enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid plan, could lose coverage.

The governor acknowledged that at least part of that — perhaps 200,000 — would be due solely to new requirements for able-bodied individuals to work or be engaged in community service for at least 80 hours a month. There are only limited exceptions, like for pregnant women.

Hobbs said there’s nothing wrong with a work requirement. In fact, AHCCCS has submitted its own proposal to the federal Center for Medicare and Medicaid Services.

The governor, however, said what the House has approved is far stricter than the plan the state is offering which has nearly two dozen exceptions.

The event, organized by Hobbs, was billed as a “roundtable” for hospital officials to detail how they will be affected. But it also was designed to get as much publicity as possible, with reporters invited to sit in to hear their concerns.

Some of the stories focused on dollars.

Todd LaPorte, CEO of HonorHealth, figured his network of hospitals in the Phoenix area would lose about $600 million a year out of a “topline” budget of $4 billion.

“We view health care as basic infrastructure to a vibrant business in the state,” he said.

But Dave Cheney, CEO of Northern Arizona Healthcare, said the situation goes beyond lost revenues for rural operations like his.

“I’m not sure how many rural hospitals would survive,” he said.

And Neal Jensen, CEO of Cobre Valley Regional Medical Center, said the effects on facilities like his in Globe could be dire. He said that pregnant women who now come to his hospital would otherwise have to drive 90 minutes to the Phoenix metro area.

“I think about the mothers we would have probably lost last year if we didn’t have a hospital,” Jensen said.

At the center of all of this is the federal legislation that Democrats say will cut Medicaid funding and result in fewer people with coverage but that Republicans contend simply tightens up enrollment restrictions and cuts what they say is waste, fraud and abuse in the program. And central to that is whether those who are getting free health care should be required to work.

Under the GOP plan, there would be exceptions not just for pregnant women but also for certain others, including those with serious or complex medical issues, parents who are caregivers to a dependent child, and those participating in drug or alcohol treatment programs. There also are some special circumstances for short-term hardships like those in a federally declared disaster area or living in a county with a high unemployment rate.

“If you are able to work, and you refuse to do so, you are defrauding the system,” House Speaker Mike Johnson said this past Sunday on Face the Nation. “You are cheating the system. And no one in the country believes that’s right.”

Hobbs said she has no problem with the concept — at least on paper.

“People who can work should work,” she said. “There’s no disagreement there.”

It’s when it comes to the details that the governor contends the Republican-controlled House has gone too far.

“There’s also a lot of evidence that very stringent work requirements don’t work,” Hobbs said, citing what she called “failed experiments in Georgia and Arkansas.”

In the latter case, the Urban Institute said their examination of the program found that the state’s work requirement reduced the number of adults with health insurance coverage — but had no effect on employment.

Hobbs also said the costs of administering such a program are “extraordinary and won’t actually end up saving a lot of money.”

“It will just cause people to fall off the health care that they need,” she said, having the “ripple effect” that was cited by the hospital executives.

And LaPorte said that the work requirement is being put out front by proponents of the measure “to justify what is a whole portfolio of things that, at the end of the day, net, are going to be a disastrous impact on our industry.”

Among those other things are requirements for people to prove every six months they remain eligible for coverage, twice as often as now required. And even those who are applying for a first time would have to show they have met the work requirement for at least one month before applying.

“This will just cause people to lose care because of administrative red tape,” she said.

There also are provisions that would curtail federal funding for services to those earning above the federal poverty level as well as impose cost-sharing requirements.

And the governor said she is particularly worried that the U.S. Senate, also in Republican hands, may approve “more drastic cuts.”

Hobbs said the state has submitted its own plan to impose work requirements for those on AHCCCS.

It does have many of the same exceptions as the federal bill like for pregnant women, caregivers and those who are being treated for substance abuse disorder.

But there are others that Arizona wants to exempt.

The state would not impose a work requirement on those who are at least 56; the federal bill covers everyone through age 64. Also exempt would be the homeless, domestic violence victims, full-time trade school, college or graduate students, veterans regardless of their discharge status, and anyone who has been incarcerated within the past six months.

Cuts to AHCCCS threaten Arizona’s health, economy and vulnerable families

Graham B. Johnson

In Arizona, Medicaid — known as AHCCCS — is not just a budget line item. It’s a lifeline for 2 million people, including one in three children. 

This program is crucial not just for those it directly covers, but for every person in our state. Yet today, this critical program is under threat. Congressional proposals to reduce Medicaid funding would significantly impact Arizona’s health care landscape, undermine access to essential primary and behavioral health services for highly vulnerable populations and destabilize our state’s health care economy. 

Looking at the numbers makes the urgency of this situation even clearer. Last year alone, AHCCCS provided health care to roughly 64,000 Arizonans battling cancer, 450,000 with heart disease, 700,000 dealing with respiratory conditions like asthma and COPD, 68,000 individuals affected by opioid-use disorders and 660,000 experiencing mental, behavioral health and developmental disorders. Behind these numbers are real people — patients who rely on providers like Denova Collaborative Health every day.

At Denova, Arizona’s largest outpatient behavioral health provider, we witness daily the integral role AHCCCS plays. Medicaid funding ensures our providers can provide timely care, preventive services and treatment for chronic conditions. 

Reductions in funding would not just mean fewer doctor visits — it would mean more costly emergency room visits, increased insurance premiums and the tragic reality of untreated chronic illnesses and mental health conditions. Additionally, untreated health conditions do not simply vanish; they escalate, driving up emergency care costs and hospitalizations that could have been avoided with preventive care.

Cuts to Medicaid funding would do more than just limit coverage; these cuts would ripple across Arizona’s entire health care system. A loss in revenue could force providers to reduce services, close clinics, or even hospitals, creating a health care crisis for everyone, not just Medicaid recipients. Rural hospitals, already stretched thin, would face an especially stark reality: service cutbacks or even closure, leaving some communities without essential health care services. 

Additionally, Arizona ranks alarmingly high for mental health challenges, and Medicaid is the backbone of our response. At Denova, we prioritize quick access to mental health services — offering same-day or next-day appointments — to ensure immediate care when patients need it most. AHCCCS funding supports this critical infrastructure, ensuring adolescents facing anxiety or depression, new mothers experiencing postpartum mental health challenges, and individuals struggling with substance use can receive timely intervention and consistent, quality care.

Beyond health care, AHCCCS is a significant economic driver. Arizona’s health care sector directly employs over 400,000 workers statewide. A cut to Medicaid funding would lead to job losses and reduced economic stability, impacting Arizona’s overall economic competitiveness. Proposed Medicaid cuts would likely force the state to eliminate Medicaid expansion and could lead to the loss of an estimated 300,000 jobs across multiple industries and a $30.9 billion reduction in Arizona’s economic activity.

At Denova, we believe health care should be a right, not a privilege. Our experience treating patients has shown us that AHCCCS is indispensable to fulfilling this promise. The current debate in Congress over cutting funding is not just a policy disagreement — it is a pivotal decision about our state’s future health, well-being and economic strength. Equally important, we believe, fully funding Medicaid is simply the right thing to do for Arizona’s most vulnerable.

We urge Arizona’s Congressional delegation to unequivocally support Medicaid funding, protect health care access, and safeguard our local decision-making authority. Let’s ensure every Arizonan continues to receive the quality health care they deserve, maintaining a healthier Arizona for generations to come.

Graham B. Johnson, MAcc, CPA, is the CEO of Denova Collaborative Health, Arizona’s largest provider of outpatient behavioral health services, offering same day, next day appointments for psychiatry, therapy and primary care. 

AHCCCS and DHS directors resign

The directors of the Arizona Health Care Cost Containment System and the Arizona Department of Health Services resigned Thursday “after it became clear to the Governor’s Office that the Senate Majority will refuse to confirm their nominations,” according to a press release from the Governor’s Office. 

In a lengthy statement, Gov. Katie Hobbs defended both nominees, stating that their resignations had nothing to do with their leadership at either department.

“Unfortunately, the Senate’s unprecedented politicization of the director confirmation process has ended the directorship of two healthcare professionals who have made our state government run more efficiently and more effectively,” Hobbs said.  “The people of Arizona are tired of the relentless politics that has undermined good governance in the name of partisan retribution. It should not matter whether the leaders of our state government are Democrats or Republicans; it should matter that our state is run by public servants who do what’s right for everyday people.”

Carmen Heredia was appointed to the AHCCCS director position in January 2023. She came to AHCCCS from Valle del Sol, a nonprofit community health organization focused on services for the Latino and underserved communities. She served as the organization’s chief executive officer from 2019 to 2023 and chief operations officer from 2013 to 2019. 

Heredia was expected to appear before the Senate Director Nominations Committee on Thursday, where lawmakers would have had the opportunity to question her about recent department issues and scandals, including the sober living home fraud, improperly issued contracts, and the Parents as Paid Caregivers Program. 

Sen. Jake Hoffman, the chair of the DINO committee, called Heredia “unqualified” and cited her response to the sober living homes scandal and the agency’s issues with its procurement code in his own lengthy statement.

“We look forward to Katie Hobbs sending us a sensible leader that will be able to rein in the abuse that has occurred at AHCCCS,” Hoffman said in his statement.

Will Humble, the executive director of the Arizona Public Health Association and a former director of the Department of Health Services, told the Yellow Sheet Report before Heredia’s resignation was announced that stakeholders largely supported her nomination and enjoyed working with her.

Jennie Cunico was a longtime employee of ADHS and was appointed director in December 2023 after Hobbs’ first pick to lead the agency, Theresa Cullen, resigned. 

In a post on X, Hoffman attributed Cunico’s withdrawal to “a disastrous one-on-one meeting.”

“During this meeting, Jennifer Cunico double and tripled down on the systemic failures of public health officials during the COVID years, even going so far as to defend policies that even the CDC and WHO have now admitted were wrong and not rooted in science.”

An open letter to Congressman Ciscomani

Dear Congressman Juan Ciscomani: 

Clinton Kuntz
Clinton Kuntz

I am Clinton Kuntz, CEO of El Rio Health, a vital community health center in Tucson and your constituent. I’ve had the pleasure of meeting with you several times to discuss health care and the community health center program. Each time, you’ve shown a willingness to listen, an eagerness to learn about these complex issues, and a genuine commitment to understanding the needs of the people you serve. Your dedication to representing southern Arizona with thoughtfulness and integrity has not gone unnoticed.

Today, I’m writing with a deep sense of urgency about the potential cuts to Medicaid and the devastating impact they would have on Arizona, especially on organizations like El Rio Health. These cuts would disproportionately harm the communities we both serve, including the Hispanic population, which comprises 60% of our patients.

We often hear that Medicaid cuts are not on the table, but the numbers tell a different story. A Congressional Budget Office analysis shows that the available funds Congress can cut fall far short of the $880 billion in reductions required by the budget resolution without deep cuts to Medicaid. That means Medicaid will almost certainly face deep cuts, despite any assurances to the contrary.

Medicaid, known in Arizona as AHCCCS (Arizona Health Care Cost Containment System), is a lifeline for over 2 million Arizonans, providing essential health care to children, pregnant women, seniors, people with disabilities and low-income families. In Pima County alone, nearly 400,000 people depend on AHCCCS for their care. These aren’t just statistics, these are your constituents, my patients, our neighbors.

El Rio Health serves over 129,000 patients annually, nearly half of whom rely on Medicaid. We ensure that people get the care they need to live healthy productive lives. Without Medicaid funding, our ability to care for many of them will be severely limited, leading to worse health outcomes and higher costs for everyone.

When people lose coverage, they don’t stop getting sick. They postpone treatment until it’s an emergency. That means more crowded emergency rooms, the most expensive place to get care, because they have nowhere else to go. Emergency rooms can only stabilize a crisis, so patients leave without solutions for when they need follow-up care. Without follow-up care, they get worse, end up back in the ER, and the cycle repeats.

Medicaid isn’t government bloat — it’s a smart investment that lowers the overall cost of health care and keeps Arizona’s economy strong. Cutting it doesn’t eliminate health care costs; it just shifts them elsewhere.

To understand the real-world impact, El Rio worked with Capital Link to model different Medicaid cut scenarios. One projection shows that El Rio alone could lose $23 million annually starting in 2026. That means thousands of jobs lost, not just at El Rio, but across health care, food service, child care and other industries. The impact wouldn’t stop with our staff or our patients. Fewer jobs mean less money flowing through local businesses, more families struggling to make ends meet, and a community less able to support itself. And El Rio is just one of 1,400 health centers across the country.

Every hospital, every doctor’s office and every community would feel the blow. The ripple effect would be felt in business closures, overwhelmed hospitals and higher costs for taxpayers and local communities. The economic tsunami of Medicaid cuts cannot be overstated.

Congressman, I know this won’t be an easy vote. Leadership means making tough choices. Your duty is to the people who trust you to lead. Medicaid is a lifeline for families, workers and businesses in your district. Cutting it would destabilize our economy, cripple our health care system, and put lives at risk. This isn’t hyperbole, this is the reality of the situation.

When people lose coverage, they don’t just suffer financially, they suffer physically. A mother in your district will struggle to get prenatal care, putting both her and her baby at risk. A child with asthma will go without an inhaler. A senior will skip medications, leading to a stroke. And they will all end up in an overwhelmed ER for something that could have been prevented.

This isn’t just about numbers on a budget, it’s about real people, real families and real jobs in your district.

Congressman, I urge you to stand with the people who elected you. Protect Medicaid. Protect Arizona’s families. Protect our economy. This isn’t just a policy decision, it’s about who we are as a community and the future we build together.


Clinton Kuntz is the CEO of El Rio Health.

 

In Their Words: Carl Kunasek

Carl Kunasek left a large mark on Arizona as a Republican member of the Arizona State House of Representatives from 1973-1982, the Arizona Senate from 1983-1988, and the Arizona Corporation Commission from 1995-2000. Kunasek was one of the architects of the Arizona Health Care Cost Containment System, better known as AHCCCS, the state’s Medicaid program, and in the oral history below he talks about the events that led to the agency. He also tells a humorous anecdote about flying over flooded river crossings before the passage of flood plain legislation, and his memories of the impeachment trial of Gov. Evan Mecham when he was the Senate president. Kunasek’s children, Andy Kunasek and Karrin Taylor Robson, have followed in their father’s political footsteps, with Andy Kunasek serving on the Maricopa County Board of Supervisors from 1997 to 2006, and Robson running for governor in 2022 and announcing her run recently for the 2026 campaign. 

The following interview is part of the Arizona State Library Oral History Project, which started in 2006 and is printed here as an occasional feature called In Their Words. It has been edited for space and clarity. 

On what triggered the need for AHCCCS

We passed the Medicare enabling legislation, but at that time, the Legislature was controlled by the Republicans and very conservative. 

The leadership was able to get enough Republican crossover votes to pass it, although it was very close, as I recall.  But the conservatives didn’t fund it, so that then languished for 15 or 20 years – no, probably 10 or 12. Then the later years of objecting to money was very easy, because all of the scandals on the East … 49 other states had it but they were all becoming scandal ridden, money, fraud, doctors ordering stuff that they didn’t need, labs billing, hospitals billing, nobody knowing what’s going on because it was essentially a credit card operation. 

You could go into the doctor, he’d say, “OK, you need this, you need this, you need this and go get this, and this, and this, and this,” he’d send you a bill, and everybody would send Medicare a bill. Then the place is running wild. Nobody is auditing or giving any accounting. Was the lab doing all this lab work? Did the doctor actually do three physicals? Maybe he only did one. There were never any audits. And so this is where the fraud came down in these states, I always say eastern states, but it was all, it was pervasive across the country. So that made it easier for us never to fund it. Look at all the fraud, look at them wasting money. 

Late in my House tenure we had a situation developing in Arizona. The Arizona Constitution says the counties are responsible for delivering health care, and therefore they had a responsibility for paying for it. I don’t remember if the state was doing any funding for the health care but in the late 70s, there were some incidents that really brought it home as to the burden that this was placing on the counties. The most significant one was – Arizona has always had a lot of winter visitors – there was a motorcycle accident of a fellow from Ohio. Ohio had Medicare, but there was no provision in Medicare for Arizona to bill Ohio Medicare. The man was in the hospital running up hundreds of thousands of dollars in medical bills.  

Cochise or Santa Cruz County (Kunasek could not recall in which county the accident occurred) is a very small county when it comes to taxable property  and they were way upside down in debt for this one medical case … close to millions of dollars. And so it became very apparent we were going to have to do something and so I became very interested in looking at how we might approach this. And again getting back to the moral issues. I thought in learning what had happened to these other states, what we had to have was some other form of delivery that we could qualify to get some of those Medicare funds.  

On flood plain legislation

Back then, there were only two bridges you could get across the Valley on. And anytime it rained and the river was running, the old bridge in Tempe and then eventually the second bridge was I-10. 

One year we had a fella in the Legislature that was a pilot, Doug Todd, and he had an airplane he kept at Stellar Air Park, which is a private airfield in Chandler, and there were four legislators that lived on that side of the river. And so the river had been up, I don’t know how long, it just took a long time to drive back and forth. So Doug said, “Why don’t we get together? If we’ll all buy a little gas, I’ll fly us.” So that’s what we did. We all met, myself, Juanita Harrelson, Jamie Sossaman and Doug. We met down at the airplane, a 5-minute flight across the river. (Phoenix Mayor) Margaret Hance let us park at the city of Phoenix airplane pad. We kept a car there, one of us left a car there, and we get in the car and drive to the Capitol. That made a nice news story, too, when the newspapers discovered it. Oh, legislators could care less about the flooding, they fly over it, and they list all our names. 

We were fighting to get bridges. That’s what we’re trying to do. And so then I got involved in a piece of legislation that … it was to prohibit building a house or any other structure that would be occupied by human beings, by humanity from preventing that from being built in a flood plain. And you had to, the communities and the political subdivisions had to identify the 100-year flood plain. None of that had been done yet, but it was available to be done. So we passed a law that said they could not issue a building permit in the 100-year flood plain. And then to get their attention, to put some teeth into it, in the event they didn’t have this 100-year flood plain identified in such and such a time, the state would withhold their share of the sales tax. That really caught their attention. And so we, of course, then the bill really starts to get a life of its own, and it’s just ironic that God was helping – every time we scheduled a hearing it would rain and crossings would be closed. So we got that bill passed out here very easily. You can drive around and see the development where they’ll have flood retention basins. 

On the Evan Mecham impeachment trial

It was very tumultuous, and it took a lot of energy. Everybody’s energy was focused on the governor. And I believe that Governor Mecham was a good man. I agreed with a lot of what he wanted to do. We had the same, I would say we had the same moral agenda, family, Christian beliefs, and I think we had the same moral agenda on abortion, all these things, children and family most important. So I had no trouble with that part of the relationship. I did have some trouble with the relationship in his style, his management style, and his management style was what really caught up with him in the end.

If you look at the Constitution, and my reading of it, very straightforward and simple English language, when the House brings articles of impeachment, when they vote articles of impeachment, those articles then are delivered to the Senate, the Senate must conduct the trial. I didn’t want to conduct a trial. I just felt that it was unneeded. I talked to Joe Lane, who was the speaker of the House, and I said, “Joe, be sure before you bring that to a vote in the House, let’s talk. Make sure if that does come out, that it will get a good trial in the Senate.” It did get a good trial in the Senate. I would have liked to have avoided it in some way, but there was no way I could avoid it. 

And then the issue is, how are you going to run this? You’re going to recess while the trial’s going on? And I don’t know who came up with the idea that we would convene the Senate every morning, do whatever had to be done. And then we would recess to go into the court mode. So we did that, and that took two months, and then we got blamed for conducting the longest session ever conducted in the history of Arizona. Come on, two months of it was a trial, but we didn’t adjourn (Sine Die) until the trial was over. So that’s what happened.

I don’t think there’s ever been the impeachment of an executive officer in the country, in the United States, may have been, I’m not aware.

You know, I was sad. He had his own style. That was his style, a lot of members didn’t agree with it. I didn’t agree with it. That was his style, he was elected. 

I did not, I had no ability to stop the trial. There could have been motions made by a member that could have led to the stopping of the trial, but I, as far as I know, I was not aware of any mechanism that I as Senate president had to stop the trial. So we conducted the trial, and we got through with it. So that happened, and then I ran for re-election and was not re-elected from the same district. In other words, I think a lot of his supporters in Mesa thought I should have stopped the trial, and they can think that, but there was no way I could do it.

You don't have credit card details available. You will be redirected to update payment method page. Click OK to continue.