Medicaid Coverage for Childless Adults

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Arizona Republic reporter Mary K. Reinhart explains why thousands of childless adults could lose their Medicaid coverage under the State’s AHCCCS program at the end of 2013.

Ted Simons: Good evening. Welcome to "Arizona Horizon." I'm Ted Simons. Arizona's Medicaid program known as access is preparing to ask the federal government for permission to continue covering childless adults. Access also wants more federal dollars to help pay for that coverage. Childless adults are not normally covered by Medicaid but 12 years ago Arizona voters passed a proposition that mandates access coverage for anyone with an income below 100% of federal poverty level. Last year Arizona lawmakers frozen enrollment for that population due to the state's budget crisis. Thousands of people lost their Medicaid coverage and thousands more stand to lose coverage at the end of next year. Here to help clarify all of this is Arizona Republic reporter Mary K. Reinhart. Good to have you. I hope you can clarify this. This is pretty complicated stuff.
Mary K. Reinhart: It's a long slog.
Ted Simons: It is. The status of Medicaid for childless adults right now. Mary K. Reinhart: It is frozen. It's capped. The program does not allow any new people to sign up. That was done by the legislature. It was upheld ultimately through the court system. So the folks on there now, as long as they don't get dropped off because they earn too much or don't do the proper paperwork or something else happens, they continue to be covered. That's about 100,000 people. That program served about 220,000 when it was capped by the legislature and the governor.
Ted Simons: it expires at the end of next year if there's no federal extension. Correct?
Mary K. Reinhart: That's correct. That was the whole access program is a waiver. Many states have very demonstration projects called waivers. This particular part of our access Medicaid program, the childless adult program, is on a waiver due to expire at the end of 2013. We picked that date because we thought next day, January 1, 2014, everybody under 133% of poverty level would be covered under Medicaid under the affordable care act. The Supreme Court came along in June and said, we don't think we should penalize states if they don't want to participate so we'll give them the option of opting out of the Medicaid expansion. Our state is still weighing what to do about that.
Ted Simons: So obviously we could go the full 133 and how much would that cost the state as opposed to opting out and only keeping it up to 100%?
Mary K. Reinhart: 133 -- we're not even looking at those numbers now. Politically it's probably not doable given the climate at the legislature, the way -- a lot of folks including the governor and leadership in-house and Senate, previous leadership, want to repeal the entire affordable care act. The odds of them expanding Medicaid to the full 133 are not good. We want to be clear. We're talking about two separate things. One is restoring this population that voters said they wanted covered up to 100%. That's what the state is asking to do. The other is the expansion to 133. If we restore childless adults, sure, extend that program, that would cost us at the current rate of match rate we share responsibility with the federal government, they pay about $2 for every $1 we pay. Right now it will cost us about $2.5 billion over the first four years. The other thing we're asking the federal government to do, let us extends this program and if you wouldn't mind give us the enhanced match rate under the affordable care act that the rest of the folks are getting which is up to 90%. So the state would pay about 10% for these new folks at a cost of considerably less than that, less than $1 billion over the first four years of implementation.
Ted Simons: That's a better match, that 90%, is that for the full 133 or does that stop at 100 as well? In other words if you're a state that's going full bore into the affordable care act I imagine you get close to 100% match. If you're like Arizona we don't want to go to 133 are you stuck at 66%?
Mary K. Reinhart: That remains to be seen. The federal government for other states that haven't covered this population, we're one of only six states that cover childless adults. There's no requirement in Medicaid to do that. Our voters decided to do that in 2000. Other states that are bringing these people on, agreeing to expand to 133% are getting match rates of 80 to 100%. I forget the exact percentage. The federal government is making it easy to add them on to the Medicaid system. Arizona's concern is that we are being penalized essentially for having already covered these people. What we're being offered is that two-thirds match rate as opposed to the 90% that other states -- 90 to 100% in some cases that other states will get.
Ted Simons: So we have two different issues here. Whether or not the childless adults will even be covered by the end of next year and what kind of matching rates we'll get from the federal government. Correct?
Mary K. Reinhart: Correct. That's the biggest concern for access officials, certainly for health care administrators and advocates in the community, is that if the federal government, for whatever reason, does not agree to extend this waiver to allow us to restore coverage to the childless adult population, they have no options. They will not be covered. They will literally be kicked off coverage come January 1, 2014. They won't have the option to go on to the health exchange and obtain insurance as those between 100 and 133% will.
Ted Simons: Why would they not have that option? I thought that was supposed to be available for everyone.
Mary K. Reinhart: Everybody over 100%. It was envisioned everybody over 133%. So there is a provision that you're getting subsidized coverage on the exchange depending how much you earn. People between 100 and 133%, the way the rules are now, can get 98% subsidized coverage on the exchange. They have to pay about 25 bucks a month plus co-pay. For someone on low income that still amounts to quite a bit of money but still an opportunity to be covered under -- to get health care coverage. The way the law is between our waiver and the law there's this huge doughnut hole, if you will, that all of those folks under 100% of the federal poverty level -- the Feds envisioned they would be part of the same Medicaid coverage.
Ted Simons: The state is saying, your goal is to get everyone some sort of coverage, the state says everyone is not going to get coverage if you don't help us out.
Mary K. Reinhart: The state says we need your help to restore and cover these people up to 100% and if you increase the match rate it will make things a lot easier we hope to convince the legislature to go along. The governor is generally supportive of in her administration from all the meetings they have been holding with stakeholders of restoring the childless adult population. She wants the best match rate she can. She wants to pay $100 billion instead of 2.5 billion in the first four years. There's also the real concern even restoring the childless adult population in the coming legislative session could be very difficult to do. There are people who don't see any reason to cover this population with health care. So they want the affordable care act repealed. So the idea is with this carrot, if you will, this better match rate of 90%, we might be able for convince more lawmakers to restore this population.
Ted Simons: Real quickly, we had a public hearing on this earlier this week. What was said and what dates now do we have to look for for more hearings? We have a website where you can go to do public comments. Get those in there. What's the timetable for all this?
Mary K. Reinhart: There is no real timetable for Medicaid expansion from the federal government's perspective. There is for the health exchange, but states are being told you can expand and then two years later if you don't like it you can go back. The federal government has not issued a lot of guidance. A lot of the states other than some that have already said they aren't going to expand are waiting for more instruction. There are a couple more hearings on these issues that access holding. The public comments are very important. The questions and comments and concerns along with the answers from access are all going to be sent to the federal government, to the centers for Medicare and Medicaid services. That will be on the record. We believe that from what we're hearing the governor will make a decision probably sometime after the election about which way to go. That decision will be reflected in her budget at the beginning of the year.
Ted Simons: We'll keep an eye on. That thanks for helping on this. It's an awfully confusing topic but important to a lot of folks.
Mary K. Reinhart: it was my pleasure.

Mary K. Reinhart:Reporter, The Arizona Republic;

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