Governor’s AHCCCS Plan

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Governor Doug Ducey has announced a plan that would institute co-pays and make other changes for many of those on the Arizona Health Care Cost Containment System, Arizona’s Medicaid plan. Arizona Republic reporter Mary Jo Pitzl will tell us more.

TED SIMONS: Good evening. Welcome to "Arizona Horizon." I'm Ted Simons. The state Court of Appeals today refused to immediately hear superintendent of public instruction Diane Douglas's arguments that she, and not the board of education, has the power to hire and fire board employees. A lower court had dismissed Douglas's lawsuit over control of the board. Douglas wanted her appeal expedited by way of special action but the court today said no. An attorney says the appeal will continue but it will just take longer now. Governor Doug Ducey has announced a plan designed to reduce the number of Arizonans enrolled in AHCCCS, the state's Medicaid program. Arizona Republic's Mary Jo Pitzl is covering the story and she joins us now. Good to see you here, thanks for joining us. What exactly is the governor's proposed plan. How much is new?

MARY JO PITZL: The governor's calling this access care. I think sort of a takeoff on Medicare. What his plan is it's a combination of measures passed by the legislature this last session, which he signed into law, and new things that he added. The intent is to create a little more personal responsibility for people who are using the state's insurance program for low income. He's doing this now because our access to system operates understand a waiver from the federal government. You have to renew that every so often and the next renewal period is next year, so here's a good time to let's try some of these things. Most are probably going to need federal approval before they can happen. So they are putting some old ideas out there and new twists.

TED SIMONS: We'll get to the challenge of that federal approve here in a second, first of all it increases co-pays up to 3% of household income. Is that a new idea?

MARY JO PITZL: The legislature has tried before to talk about co-pays. The Feds reject that idea. This says yes, a co-pay for certain -- not for everything but things that the state might want to discourage people from using. You don't need to go to the E.R. if you can get a doctor's appointment. Up to 3% more, so they would use it more as a disincentive in the hope that people would not pay because they may not have the money to pay, make them think twice about how they are using their AHCCCS service.

TED SIMONS: up to 2% of income into a health savings account. What is this?

MARY JO PITZL: That's a new wrinkle that Ducey brings to the table. This is modeled after what's been done in other states. He talked about this during the campaign, about having health savings accounts. If you are a low income person you're on AHCCCS you need to pay about 2% of your income into this account that the state will keep for you. You can use that money to pay for services that are outside of AHCCCS. So they see an opportunity there to maybe try to leverage this is with a bunch of charitable contributions to provide dental care to people that don't have a benefit or vision care. The question is how do you get 2% out of really low income people.

TED SIMONS: Indeed. Also an increase in work requirements. Talk to us about that.

MARY JO PITZL: Yes. His plan hinges on three components. You have to contribute to the health savings account, which I think would have a different name. You must be employed or looking for work, and they are building incentives in to help people, maybe job training, resume building, maybe some coaching to help people be a little more assertive on a job interview. Then thirdly, certain health measurements. A lot of us in the private sector use of insurance companies saying we need bio metric reads from you. You need to send us your blood glucose and cholesterol levels. There's talk about establishing a couple of health benchmarks and requiring people to meet though as well to stay on AHCCCS.

TED SIMONS: Indeed, so what happens if you don't -- the 2% savings account. What happens if you don't show you're active -- how are you going to prove your actively looking for work or actively going through job training programs?

MARY JO PITZL: They have a model already with unemployment.

TED SIMONS: So something similar to unemployment.

MARY JO PITZL: It would probably be housed at the department of economic security.

TED SIMONS: What if you don't do those things? What happens?

MARY JO PITZL: If you make above the federal poverty level you get kicked off the program for six months. You can reapply after six months. If you make below the poverty level, 2% you're not paying is considered a debt to the state and maybe the department of revenue will find a way to deal with that down the road, perhaps in the form of a tax lien. They haven't worked out the details.

TED SIMONS: Affects only able bodied adults.

MARY JO PITZL: That's really important. AHCCCS serves 1.7 million Arizonans. This applies to about 350,000 adults that are called able bodied meaning it's determined they can work, they are just --

TED SIMONS: I was going to ask Howe do you defined able bodied? Who does the definition?

MARY JO PITZL: The state does. I think it's through federal guidelines. These are people that they believe can work. In fact I think many of them do work and yet they still earn so little that they qualify for Medicaid. But this will not affect children, the elderly, the seriously mentally ill. Many of the other populations that AHCCCS serves.

TED SIMONS: So did I read 300 some odd thousand or something like that?

MARY JO PITZL: Under current enrollment.

TED SIMONS: So we brought up the federal approval it is necessary, is it not?

MARY JO PITZL: Yes. Anything that goes into the waiver that would allow the state to operate the AHCCCS program for another ten years needs the blessing of the centers for Medicaid an Medicare services.

TED SIMONS: Can the Feds look at this and say I like A, B, adopt like C, we'll help you with D, not with E.

MARY JO PITZL: I think so. It's all a negotiation. They are starting public hearings later this month. There's one August 18 in Phoenix, two hearings the same day actually. To start pulling in more ideas. Then it becomes a bit of a negotiation. There are a couple other elements to Ducey as plan that don't require the Feds. They want to start using technology. They say they did a survey and found out most access patients have smart phones so they are working on a app that people could download that would allow you - that would serve as a reminder, here's your doctor apartment. Have you gotten your flu shot? Have you met these requirements for our wellness program?

TED SIMONS: The idea is to get people out of the system. That's the bottom line.

MARY JO PITZL: Very much. More so to get them out of that system and into good earning jobs. There should be a cost savings but they say they have not crunched the numbers to know what that might save the state.

TED SIMONS: All right, thanks, Mary Jo. Appreciate it.

Mary Jo Pitzl:Arizona Republic Reporter

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