Assigned to HHS AS ENACTED
ARIZONA STATE SENATE
Fifty-Second Legislature, First Regular Session
FACT SHEET FOR H.B. 2075/S.B. 1092
AHCCCS; annual waiver submittals.
Requires the Arizona Health Care Cost Containment System (AHCCCS) Director (Director) to apply to the Centers for Medicare and Medicaid Services (CMS) by March 30 of each year for permission to institute cost-sharing requirements, work requirements and lifetime limits for adults receiving AHCCCS benefits.
Laws 1981, 4th S.S., Chapter 1, created AHCCCS, Arizona’s Medicaid program, to provide acute medical services to low-income Arizonans and in 1987, AHCCCS was expanded to include long-term care services through the Arizona Long Term Care System (ALTCS). Medicaid is the federal healthcare program administered by the state of Arizona and jointly funded by the federal and state governments. Within Arizona, the program operates primarily as a managed care system that entails AHCCCS contracting with health plans that coordinate and pay doctors and hospitals for medical services for eligible individuals and families.
The Section 1115 Waiver refers to section 1115 of the federal Social Security Act (SSA). States are required to comply with Title XIX (Medicaid) and Title XXI (Children’s Health Insurance Program) of the SSA. Since Arizona has been providing Medicaid services, AHCCCS has been operating under an 1115 Research and Demonstration Waiver that exempts AHCCCS from certain provisions of the SSA. Any modification to the waiver must be submitted and approved by CMS. A recent waiver amendment approved by CMS allows AHCCCS to use Safety Net Care Pool funding for Phoenix Children’s Hospital and to continue uncompensated care payments through December 31, 2014. Current pending waiver amendments include: 1) imposing mandatory cost sharing on the expansion population; 2) expanding integrated health services to individuals with serious mental illness; and 3) authority to support a medical home program for the fee-for-service population (azahcccs.gov).
Assuming CMS approves an amendment to Arizona’s Section 1115 Waiver related to a lifetime limits or copayments, there would be a positive impact to the state General Fund.
1. Requires the Director, by March 30 of each year, to apply to CMS for waivers or amendments to Arizona’s Section 1115 Waiver to allow Arizona to:
a) institute a work requirement for all able-bodied adults receiving AHCCCS services, excluding long term care, and stipulates the work requirement must:
i. require an eligible person to become employed, actively seek employment, attend school or a job training program, or both at least 20 hours a week, and to verify compliance with this requirement and any change in family income;
ii. require AHCCCS to verify when a person is seeking employment and to confirm changes of family income and redetermine eligibility for services;
iii. allow AHCCCS to ban an eligible person for one year if the individual knowingly fails to report family income changes or makes a false statement regarding work-related requirements; and
iv. allow for an exemption if a person is:
· at least 19 years of age and still a full-time student in high school;
· the sole caregiver of a family member who is under six years of age;
· currently receiving long-term disability benefits from the government or a private insurer; or
· determined to be physically or mentally unfit for employment by a health care professional in accordance with AHCCCS’ rules;
b) place a five-year lifetime limit of benefits on able-bodied adults that begins on the effective date of the waiver or amendment to the current waiver, excluding any previous time a person received AHCCCS benefits;
c) states the lifetime limit of benefits on able-bodied adults does not include any time during which a person is:
ii. the sole caregiver of a family member who is under six years of age;
iii. currently receiving long-term disability benefits from the government or a private insurer;
iv. at least 19 years of age and still a full-time student in high school;
v. employed full-time but continues to be eligible for AHCCCS;
vi. enrolled before reaching 19 years of age; or
vii. under 26 years of age and who was in the custody of the Department of Child Safety when the person became 18 years of age;
d) develop and impose meaningful cost-sharing requirements to deter:
i. the nonemergency use of emergency departments; and
ii. the use of ambulance services for nonemergency transportation or when it is not medically necessary.
2. Limits the Director to only apply for waivers or amendments to the current waiver that have not been approved and are not in effect.
3. Requires the Director, by April 1 of each year, to submit a letter confirming the submission of the waiver requests to the Governor and the Legislature.
4. Exempts AHCCCS from rulemaking requirements for one year.
5. Defines able-bodied and adult.
6. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Allows eligible persons to attend school to meet the work requirement.
2. Allows an exemption for people who have been determined to be physically or mentally unfit for employment.
3. Adds to the list of exemptions concerning the lifetime limit on benefits.
4. Replaces copayments with cost-sharing.
5. Exempts AHCCCS from rulemaking requirements for one year.
6. Limits the Director’s ability to apply for waivers.
7. Increases the age of individuals considered adults from 18 to 19 years of age.
8. Increases the maximum age of family members in the care of a sole caregiver from five to six years of age.
HHS 2/11/15 DPA 4-3-0
3rd Read 2/23/15 17-12-1
CFA 2/16/15 DPA 6-3-0
3rd Read 2/16/15 35-24-1
(S.B. 1092 was substituted for H.B. 2075 on 3rd Read)
Signed by Governor 3/6/15
Prepared by Senate Research
March 9, 2015