The state’s Medicaid program and the upcoming enrollment freeze.
Ted Simons: On Friday the state's Medicaid program, known as AHCCCS, will stop enrolling childless adults. The freeze is expected to save the state about $200 million in fiscal year 2012. The actual savings will depend on the number of people currently enrolled in AHCCCS who lose their eligibility and fall off the rolls. Here with more on the freeze is Monica Coury, assistant director of AHCCCS with the office of intergovernmental relations. In basic terms, what happens July 1st?
Monica Coury: On July 1st, we are freezing enrollment for a segment of our population that we refer to as the childless adults. In AHCCCS, we currently serve 1.35 million Arizonans. And that covers the disabled, the elderly, pregnant women, and children. The childless adult population is an extra population that we in the state cover, which is an unusual population for the Medicaid category. So about 225,000 individuals fall into that category.
Ted Simons: Who fall under the category, and give us the percentage of the poverty level, and what that means in real dollars.
Monica Coury: It is for individuals who are between 0-100% of the federal poverty level. You need to make about $903 a month or less.
Ted Simons: And that -- previous to this freeze, it was up -- how much more than that $900?
Monica Coury: It's always been from 0-100% of the federal poverty level in terms of our coverage for the childless adult population.
Ted Simons: So what about parents? Someone seems like they're above --
Monica Coury: there are some categories within our program that we do cover over the hundred percent of the federal poverty level. Those are mostly children, pregnant women, our long-term care population that serves the disabled, and the elderly and physically disabled. Those categories are over the 100% limit are.
Ted Simons: Do they stay over the hundred percent limit come July 1st?
Monica Coury: Nothing changes for the rest of our population. So this will only just stop accepting applications for individuals who fall under that childless adult category. So it norm -- what normally happens is an individual applies for the AHCCCS program, we screen them for every possible eligibility category. We check if they're -- they could fall in the pregnant woman category, child, receiving TANF, or SSi, social security income. Are they disabled? If they fall into any of those categories, they will still be made eligible for the AHCCCS program. What happens now is anyone who doesn't fall into any one of those traditional Medicaid categories gets put into the childless adult category. So on July 1 we will simply stop screening for the childless adult category. We will still screen for all the other categories like normal.
Ted Simons: What if someone, let's say, applies today, and the application can't be processed until after July 1st. And this person, after July 1st, would not have been accepted but would be accepted before July 1st. What happens?
Monica Coury: As long as you get your application in before July 1, even if we can't get to that application and process it until after July 1, you will still be made eligible.
Ted Simons: Have all the people affected by this freeze, have they been notified?
Monica Coury: Once we get federal approval, then we will send out a mass notice to all individuals enrolled in the childless adult category making them aware of the fact that this program has now been frozen, and that they need to make sure to comply with redetermination. That is, their annual renewal. We will also send a notice to the rest of the AHCCCS population letting them know that they are not being impacted by the enrollment freeze.
Ted Simons: Let's talk about people with serious mental illness. How are they affected by this AHCCCS freeze?
Monica Coury: There are some individuals in our childless adult population that have been designated seriously mentally ill. We are moving those into the -- we already have moved those individuals into a different eligibility category, which we refer to as SSi-MAO. In that category it serves the disabled population. Most seriously mentally ill individuals will likely meet the federal criteria of disability, but they will at their annual renewal, have to go through that separate process to make sure they meet that criteria. If they don't meet that criteria, we will put them back into the childless adult population.
Ted Simons: And if they don't meet that deadline, because there are some folks with serious mental illness who have trouble with things like deadlines, what happens?
Monica Coury: You mean if they haven't already applied and aren't on the program?
Ted Simons: Yeah.
Monica Coury: Well, we would hope that there are a number of providers out there who do provide assistance to the seriously mentally ill population. And we also have been working with the department of behavioral health, behavioral health services at the department of health, and our regional health behavioral health authorities, and a number of other providers that serve that population. So we're hoping that we've gotten enough information out to the community to help assist those individuals.
Ted Simons: The folks with aids, HIV, how are they affected?
Monica Coury: There are about 1200 individuals currently enrolled in the childless adult population who have a diagnosis of HIV-aids. They will not lose their coverage, just like everybody else in the childless adult population won't lose their coverage as of July 1. But if we notice that one of those individuals was HIV-aids does not meet the annual renewal deadline and therefore loses coverage because they didn't comply with that requirement, we will transfer them to that other category for the disabled, called SSSI-MAO and they will not have a break in coverage. They will have to comply that annual renewal.
Ted Simons: OK. Folks 65 and over, folks 65 and younger on Medicare. How are they affected?
Monica Coury: They are also being transferred to a different eligibility category. So as anyone ages into 65, they are considered elderly, and categorically eligible for the Medicaid program. So they will be transitioned so that there isn't any issue regarding their eligibility.
Ted Simons: And for folks who stay on the program, I guess for everyone involved with the program, the reapplication now, that time frame has changed. Correct? It's six months as opposed to a year?
Monica Coury: That hasn't changed yet. That is a proposal that is still pending before the federal government, and we won't hear back on that until the new waiver cycle, which would be October 1st. So that is not part of the July 1 freeze.
Ted Simons: OK. But that is something that is in the works awaiting federal approval it.
Monica Coury: it has to be approved by our federal partners.
Ted Simons: It just seems a lot of stuff has to be approved by the feds. There's a waiting game. What's -- give us an update on what's going on.
Monica Coury: Well, what has to be approved in order for the July 1 freeze to take effect is our phase-out plan. And you can see different drafts of that plan on our website. That plan is basically our way of showing that we're checking for eligibility in other categories, making sure that people enrolled in the childless adult population shouldn't be in some other area, want to follow up with people if they have additional information, if they become pregnant, if they have a change in their household situation or something like that. So that's what that plan is. That plan is what has to be approved by our federal partners before we can begin the July 1 freeze, and we've been working we collaboratively with them. We expect to hear something from them tomorrow.
Ted Simons: Last question, what is the department doing to be proactive with folks -- we refer to this earlier, seriously mentally ill, homeless folks who will critics are saying a large number of these people will wind up dropping off this program in one way, shape, or form. It's going to be more misery for patients, a lot of chaos in emergency rooms. We've heard all sorts of response and reactions as to what could happen. What is the department doing to try to keep those things from happening?
Monica Coury: Well, there's only so much that we can do. We will rely in large part on our stakeholders, our community partners, to assist those individuals at the ground level. But as long as, for instance, in the annual renewal time, you're getting something back to us, you're communicating with us, we take the time to work with individuals. So it's when it's in those cases when we may not hear from you at all. But people do have an obligation to provide us with some information if they've moved if they've changed their address and hopefully individuals in the community and providers in community organizations can assist those individuals. But I just want to remind people this is a two-year bridge until we get to 2014, when additional federal dollars come into play and there's a mandatory expansion of Medicaid. So this is not a permanent situation.
Ted Simons: All right. I'm glad you got that in. Thank you for joining us.
Monica Coury: Thank you for having me.
Monica Coury: AHCCCS Assistant Director
