Medicaid Enrollment Freeze

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Anne Ronan from the Arizona Center for Law in the Public Interest discusses the impact of freezing enrollment for childless adults in the AHCCCS program.

Ted Simons: Arizona's Medicaid program known as AHCCCS stops enrolling childless adults starting tomorrow. These are people who earn no more than 100% of the Federal poverty level or about $900 a month. Arizona voters elected to cover that population when they passed prop 204 more than a decade ago but because of the state's financial troubles, lawmakers and the governor decided to freeze AHCCCS enrollment for that group. The state expects to save hundreds of millions of dollars as current enrollees lose eligibility or simply fail to renew their enrollment. Last week I asked Monica Coury of AHCCCS what the agency is doing to make sure people who need Medicaid coverage keep it.

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 are getting something back to us, you are communicating with us, we take the time to work with individuals. So it's when it's in those case when is we may not hear from you at all. But people do have an obligation to provide us with some information if they have moved, if they have changed their address. And hopefully individuals in the community and providers in community organizations can assist us 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 is a mandatory expansion of Medicaid. So this is not a permanent situation.

Ted Simons: Here now to talk about the impact of the enrollment freeze is Anne Ronan, an attorney with the Arizona Center for Law and the Public Interest which attempted to stop the freeze in the courts. Good to see you again.

Anne Ronan: Thank you.

Ted Simons: What happens tomorrow?

Anne Ronan: Well, on an individual basis, what happens is a person who needs health care shows up at a provider site. Many of the providers have the ability to process AHCCCS eligibility applications right on site. That person will come in, they will screen them, take their application, they may get emergency treatment but they will be denied further treatment, further eligibility for the AHCCCS program if they call into one of the prop 204 categories that is now been closed. Who falls into those categories?

Anne Ronan: It is individuals whose income is 100 below 100% of poverty. They have made some exceptions for folks who are seriously mentally ill, HIV positive or receiving HIV treatment and for individuals on social security disability. Those folks will be, they are being transferred into another eligibility category. But to give you kind of a picture of who the people are from real human side, the AHCCCS administration put out some data about what sorts of medical issues do the people who are eligible for the prop 204 eligibility category have. And they start with motor vehicle accidents, strokes, cancer, heart attacks, respiratory infection, and the whole gamut of very serious health care problems.

Ted Simons: So where will these people go?

Anne Ronan: Well, on some level, some of them can continue to get some treatment at the community health centers. But for long-term treatment for something like cancer, the community health centers can't begin to pick up the volume. I mean, we are talking about just in the first month, the AHCCCS administration expects the this eligibility category to drop by 17,000 people. And every month, there's another group of people who either fall off or who are denied at application. And by the end of the first year, it's close to 250,000 people who otherwise would have gotten health care through our system.

Ted Simons: What are you hearing from service providers, community health organizations? What are you hearing out there as far as ramping up, getting prepared, challenges they are facing?

Anne Ronan: Well, I think they are all working as best they can to keep as many people on the eligibility rolls as possible. But the reality is they don't have any additional dollars. They just have a whole lot more people who otherwise would have had insurance and who are going to be looking to them for services. We have talked to some of the rural community providers in particular and in particular some of the rural hospitals and some of them project that if this continues, if this lack of funding for this population continues, over the next several months, some of them will have to close their doors. It's not going to be something they can work with.

Ted Simons: The idea of the spend down program, which is frozen, actually frozen, already in place. Some folks were a little confused about that but that's very interesting because some of the things you were talking about, these catastrophic illnesses, injuries very much in play in these spend downs.

Anne Ronan: That's correct. That's only complicating the situation. The population who previously were eligible for AHCCCS under a spend down provision have ongoing income that is above 100% of poverty. These are folks who have a major medical problem, sometimes it's an automobile accident, sometimes it's a heart attack, a stroke. They will go into the hospital and have emergency treatment and the cost of their emergency treatment is subtracted from their income so they were in the past eligible for AHCCCS on an ongoing basis. These folks now get the emergency treatment and have no follow-up. They have no coverage for any follow-up. We have talked to some individuals who for instance have had major surgery and need follow-up to the surgery. And they don't have the money nor do they have any insurance to get them into a doctor's office to follow-up care in a hospital for their treatment.

Ted Simons: And that freeze is already in place?

Anne Ronan: That freeze has been in place since the first of May. There are a number of many people who have been impacted by that already. The prop 204 population is being frozen tomorrow. From the folks that we see who are going to be affected, I mean, these folks have no income. The five plaintiffs in our lawsuit currently all are, have no income and four of them are living in homeless shelters. These are people with no other way to get health care other than through the Medicaid system.

Ted Simons: We heard from AHCCCS and basically, what Monica Coury was saying is that people need to be reminded this is a bridge, that when Federal health care kicks in a couple of years, these folks should be taken care of. What are your thoughts on that comment?

Anne Ronan: Well, that may be factually correct but from a human perspective that's 250,000 people in Arizona who needed health care with serious health problems who aren't going to get health care. They may get sporadic emergency care but they will not get ongoing care forever their chronic conditions. And some of the doctors we talked to who worked at the community health centers believe we will see more increased mortality as a result of this.

Ted Simons: I know that folks who have talked about the free market and when there's a need, someone will set up a business and try to take care of that need. Is that at all at play here?

Anne Ronan: No.

Ted Simons: Why?

Anne Ronan: Health care is expensive. You can't go into the health care industry with no revenue source. We have, there are clinics like the St. Vincent de Paul clinic that gets charitable donations and they see some of these folks. But they can't provide beyond sort of the basic. If someone needs surgery, for instance, one of the plaintiffs was an individual diagnosed with cancer, needed surgery--they would to find AHCCCS eligibility for this person or, you know, take out major loans in order to get his treatment.

Ted Simons: I am guessing that as soon as tomorrow hits it's not going to take too lock for your folks there to the center for law and public interest to find someone who was harmed. Is that the legal strategy? Take from it there?

Anne Ronan: And take it back into court.

Ted Simons: And that's probably going to happen two minutes after the law takes effect?

Anne Ronan: It's a difficult situation because the eligibility process can actually take 30 days or longer. So we are having to try to figure that one out, whether we could start with somebody who knows will be denied or someone wait until someone is actually denied.

Ted Simons: Last question real quickly. We have talked about this a lot on the program. There are folks with a different viewpoint and they say the state simply can't afford these folks, covering these folks any more. How do you respond to that?

Anne Ronan: William, I don't think the state can afford not to cover them. This is lots of money we are losing from the Federal government. I mean, millions and millions of dollars that we are losing and it's dollars that go into our economy and pay for staff and hospitals and nursing homes and health care centers. And it generates revenue for the state. So I think it's very short sighted. There is increased revenue that we are seeing already this year through the jail B.C. reports, and the hospitals, I don't know if you had them on but the hospitals actually proposed a tax which would have generated all the necessary revenue to continue this program over this gap period.

Ted Simons: All right. Good to have you here. Thanks for joining us.

Anne Ronan: Arizona Center for Law in the Public Interest;

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