The CMS has approved the least conservative aspects of Arizona's request to tweak Medicaid in ways that would make consumers more financially responsible for their coverage. Patient advocacy groups fought hard against the most stringent proposed requirement, one that would lock consumers out of Medicaid coverage after five years if they were considered "able-bodied." The CMS rejected the five-year limit.
The agency also denied Arizona's request to require beneficiaries to search for jobs while on the program; it also rejected locking people out of coverage for six months if they failed to pay premiums. Also refused was a request that beneficiaries living under the federal poverty level pay premiums.
The CMS will allow Arizona to charge beneficiaries with incomes above the federal poverty level premiums. Those funds will be funneled into a health savings account and cover services such as dental and vision. People living below the poverty level can then receive dental and vision coverage by volunteering to pay into the account or having a charity or third party contribute on their behalf.
In place of a job search requirement, Arizona will set up a work search and job training program for enrollees.
The CMS' move to reject Arizona charging premiums to people below the poverty line was unusual given that such plans were approved for Arkansas and Indiana.
Federal regulators said they felt the proposals would undermine access to care in Arizona. Medicaid covers 1.7 million people in the state. Since expanding Medicaid, 315,000 people have gained coverage.
Patient advocates had been most concerned by the job search requirements and five-year limits. Hospitals worried it would divert people back to overusing emergency department services.
Arizona's Republican Gov. Doug Ducey, who opposed Medicaid expansion before becoming governor, was pleased that at least some of his ideas got approved.
“When we rolled this out more than a year ago, many said it just couldn't be done—that reform was too hard, and that the federal government would never say yes,” Ducey said in a statement. “By working proactively, we've proved the naysayers wrong.”
Under the 1115 waiver, Arizona places most beneficiaries in managed care.
