Medicaid Enrollment Freeze Hearing

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Arizona has capped enrollment for childless adults in the state’s Medicaid program known as AHCCCS. Meanwhile, a challenge to the enrollment freeze was heard this week in Superior court. Arizona Republic Reporter Mary K. Reinhart talks about what went on at the hearing.

Ted Simons: A hearing was held yesterday to determine the legality of a freeze on new enrollees in Arizona's healthcare plan for the poor. Here to tell us how the hearing went and to talk about the case is Mary K. Reinhart of "The Arizona Republic." Thank you for joining us. Good to see you.

Mark K. Reinhart: Good to see you too.

Ted Simon: What happened yesterday.

Mark K. Reinhart: well, attorneys for the state and AHCCCS back in court and Judge Mark Brian's--Brains's excuse me--courtroom with facing off against attorneys for folks who either are already on AHCCCS or new plaintiffs who have been denied in the last few weeks since the freeze was put in place on for the program for childless adults; adults with either no children at all or no young children in the home.

Ted Simons: This was the same judge that did not allow the injunction, yet at the time this is different because now you've got patients actually affected, correct?

Mark K. Reinhart: Correct and one of the things that came out of yesterday is that all of the parties agreed they had standing, as you recall, before this all took effect and as Tim Hogan and these attorneys for public interest law firms were trying to get a freeze--an immediate halt--temporarily restraining order to this new cut, the judge at the time was like, "I'm not sure these people already on AHCCCS and aren't going to lose their coverage themselves, they effectively do something, don't fill out the proper paperwork, I'm not sure they have standing." Now we have four new people, both sides, the attorneys for the state agree does have standing. She's a woman whose child just turned 18, so that eliminates her from this program altogether; she no longer has healthcare coverage as of a few weeks ago. They hashed over the several arguments we're heard before over the past couple weeks, what available funds mean, which is a key phrase that attorneys for the state are focusing on. It says if you force us to fund this population of people that voters said they wanted have funded back in 2000 under proposition 204, then you're effectively doing the job of the legislature. So they've made an argument that it's a separation of powers argument that the court has no business intervening and telling the legislature how to spend its very limited amount of money.

Ted Simons: The other side is basically looking at two different things: the voters by way of initiative wanted to expand and include these people, A, and B, the constitution, the Arizona constitution says once voters say something, the legislature can't come around and change it.

Mark K. Reinhart: That's right. I mean the key point is that proposition 204 passed by voters in 2000, expanded coverage to this group of people to anybody earning less than 100% of the federal poverty limit, but secondarily, voters also approved, a couple of years earlier, something called the voter protection act which, angry at the legislature for tinkering at things that the voters passed, and said, "No more: you can't change what we've done." Tim Hogan and the attorneys for the AHCCCS plaintiff says that's what the legislature's just done. This essentially--effectively wipes out proposition 204.

Ted Simons: You mentioned the separation of powers and the idea not being able to do the legislature's job is something that the state talked about. Did they also bring up--because we talked about this an awful lot--the idea you would supplement these funds with available monies, and the governor's office and the state were basically saying the state has no monies; thus, we have to put the freeze in. Was that mentioned?

Mark K. Reinhart: Oh, sure. Yeah, the world "available" was mentioned all the time in the hearings, and again it was yesterday.

Ted Simons: Ok.

Mark K. Reinhart: The -- what is interesting, though, that - is that phrase was put in there after a whole lot of other language that says you shall supplement. If this source of funding runs--the tobacco funds runs out, the proposition 204 says the legislature shall supplement it with other available federal, state or other sources of funding.

Ted Simons: And they're saying there aren't don't have any.

Mark K. Reinhart: There are none; we don't have any.

Ted Simons: And what else is going on? As far as AHCCCS goes, I understand there are different aspects of the AHCCCS, the medicaid program, that are affected? Changed a little bit? Altered?

Mark K. Reinhart: Sure, this proposal, which is now in force--the freezing of the childless adult population was just one of I think 12 parts of the governor's Medicaid reform plan. A couple of these pieces already put in place; one of them eliminated a catastrophic healthcare plan. That happened back in May; it's frozen and will be over October 1st. And also other benefit limits take effect October 1st. Among them is a reduction to what's called respite care; you know, basically a break for families and caregivers who take care of mentally disabled or behaviorally disabled--long-term carm--people who have long-term care issue they get a break: they get about 700 hours a year. The benefit limits reduce that, not as much as AHCCCS originally proposed. The families went nuts ,and they were very unhappy about this, and they were listened to. They'll have a reduction by about 15%. Another thing that's going in is a 25-day limit to hospital--in-patient hospital stays. Anyone on -- any adult who stays over 25 days in a hospital, the hospital pays the bill.

Ted Simons: The hospitals can't be happy about that.

Mark K. Reinhart: No, they're not happy about it at all.

Ted Simons: Yeah.

Mark K. Reinhart: And they want to know--what AHCCCS is estimating is that it will cost them $65 million just in this first year alone. The hospitals are saying, "Prove it. We have no idea what it's going to cost us." So they're going to have a little meeting in about a week and a half, and they'll all figure it out I'm sure. That takes effect October 1st; barring anything else, it doesn't need federal approval.

Ted Simons: How long before the judge is expected to decide on this?

Mark K. Reinhart: He has 60 days, but he says it will take--he expects--about two weeks, and other people I've talked to said he's a pretty snappy judge, so we expect it in a couple weeks.

Ted Simons: Alright. Very good. Good stuff. Thanks for joining us; we appreciate it.

Mary K. Reinhart: Arizona Republic;

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