Arizona government tries for lifetime cap on Medicaid with Trump Administration

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Arizona has been trying to add work requirements and lifetime caps on Medicaid since 2015 with no luck, but the Trump Administration may be what they need to get those provisions passed.

Medicaid is available for disabled people. Arizona has a vague definition on what qualifies an able bodied person: 18-65 years of age and physically able to work. It’s a misconception that those on Medicaid don’t work, Swapna Reddy of the ASU School for the Science of Health Care Delivery says. Over 60 percent of those who benefit from the program are employed, but they live on a very low income, she says.

“The goal of Medicaid as it was written several decades ago and how it’s been enforced all these years is to really increase access and coverage for the most vulnerable in our population,” Reddy says. “Is that what we want Medicaid to be, or do we want to cover the least amount of people for the least amount of money?”

Kentucky and Indiana have managed to rework their Medicaid rules since the Trump Administration took over. The work requirement for Kentucky’s Medicaid program is currently in federal court. Reddy says there is concern of government overreach for this government program.

“In Arizona, we have about 1.9 million people on Medicaid,” Reddy says. “From experience, when you make it harder to enroll, you lose coverage. When you streamline and make it easier to enroll, you increase coverage. Is that our goal or is that not our goal?”

Reddy says the state doesn’t have the money to change the system at the moment. The necessary infrastructure and funds required to check people and administer an updated program aren’t currently available. It would actually end up costing the state money, Reddy says.

“The narrative and the facts aren’t on the same page at the moment,” Reddy says.

TED SIMONS: COMING UP NEXT ON ARIZONA HORIZON THE STATE WANTS A FIVE YEAR LIFETIME LIMIT FOR ABLE BODY ADULTS ON MEDICAID. ALSO TONIGHT A LOOK AT ARIZONA THEATRE COMPANY'S LATEST PRODUCTION OUTSIDE MULLINGAR AND AN ART EXHIBIT THAT COMBINES PHOTOGRAPHY AND AMERICAN INDIAN BLANKETS. THOSE STORIES AND MORE NEXT ON ARIZONA HORIZON.

SCREEN UNDERWRITER: ARIZONA HORIZON IS MADE POSSIBLE BY CONTRIBUTIONS FROM THE FRIENDS OF ARIZONA PBS MEMBERS OF YOUR PBS STATION, THANK YOU.

TED SIMONS: GOOD EVENING AND WELCOME TO ARIZONA HORIZON. I'M TED SIMONS. ARIZONA SENATOR FLAKE PLANS TO FILE A BILL THAT WILL PROVIDE A 12 YEAR PATH TO CITIZENSHIP FOR DREAMERS AND 25 BILLION DOLLARS FOR A BORDER WAL.L IT'S CALLED THE PILLAR ACT AND AMONG A NUMBER OF DACA IDEAS FLOATING AROUND THE CAPITOL. FLAKE SAYS HE WANTS SOMETHING TO GET DONE AND SOON.

JEFF FLAKE: PREFERENCE OBVIOUSLY IS TO FINISH. YOU NEVER WANT TO HAVE A BREAK RIGHT IN THE MIDDLE OF A DEBATE, THAT IS NOT OPTIMAL BUT IT'S BETTER THAN LETTING IT DIE. SO I HOPE WE CAN GETTING AN AGREEMENT BY THE END OF THE WEEK OR COME BACK THE WEEK AFTER NEXT.

TED SIMONS: ALL THIS AS A SECOND FEDERAL JUDGE TODAY TEMPORARILY BLOCKED THE TRUMP ADMINISTRATION FROM ENDING THE DACA PROGRAM. TODAY'S RULING COMBINED WITH A SIMILAR ACTION LAST MONTH PUTS THE ADMINISTRATION'S MARCH 5TH DEADLINE TO END THE DACA PROGRAM IN DOUBT. ARIZONA IS SEEKING A FIVE YEAR LIFETIME CAP FOR NONDISABLED ADULTS TO RECEIVE COVERAGE FROM THE STATE'S MEDICAID PROGRAM. PREVIOUS ATTEMPTS BY THE DUCEY ADMINISTRATION FAILED FOR APPROVAL FROM THE FEDS BUT WITH A SYMPATHETIC TRUMP IN OFFICE THE STATE IS TRYING AGAIN. WITH MORE ON THIS WE WELCOME SWAPNA REDDY FROM THE ASU COLLEGE OF HEALTH SOLUTIONS WELCOME BACK, GOOD TO SEE YOU.

SWAPNA REDDY: THANKS FOR HAVING ME.

TED SIMONS: ARIZONA WANTS TO AMEND ITS WAIVER FOR MEDICAID GIVE US THE SCENE HERE.

SWAPNA REDDY: SURE, SO FOR STATES TO CHANGE THEIR REGULATIONS AND HOW THEY OPERATIONAL MEDICAID. THEY HAVE TO APPLY FOR A FEDERAL WAIVER CALLED 1115 WAIVERS TO CMS. ARIZONA SINCE 2015 HAS BEEN APPLYING EVERY YEAR TO ADD WORK REQUIREMENTS AND LIFETIME CAPS TO OUR MEDICAID PROGRAM AND HAVE BEEN DENIED. THE LAST TIME THEY WERE LAST HEARD THEY WERE DENIED BY THE OBAMA ADMINISTRATION, BUT WE’RE AT A POINT NOW WITH A DIFFERENT ADMINISTRATION THAT IS FRIENDLIER WHEN IT COMES TO THESE TYPES OF WAIVERS.

TED SIMONS: SO WE’RE TALKING FIVE YEAR LIFETIME CAP FOR NONDISABLED ADULTS. NONDISABLED, ABLE BODIED ADULTS UNDER 65 BECAUSE THAT IS WHEN MEDICARE COMES IN, WHAT IS NONDISABLED AND WHAT IS ABLED BODIED WHAT ARE THE DEFINITIONS HERE?

SWAPNA REDDY: EXCELLENT QUESTION. SO FAR THE DEFINITION OF ABLED BODY IS SOMEONE BETWEEN THE AGES OF 19-65 RIGHT UNDER 65 THAT IS MENTALLY AND PHYSICALLY ABLE TO WORK SO IT'S JUST THAT VAGUE AT THIS MOMENT.

TED SIMONS: IS IT GOING TO GET ANY TIGHTER THERE THE DEFINITION?

SWAPNA REDDY: WE WILL SEE. WE ARE WAITING FOR CLEAR DEFINITIONS AND THE STATES THEMSELVES MIGHT HAVE MORE SAY IN WHAT THOSE DEFINITIONS ARE BUT AT THE MOMENT ARIZONA DOESN'T HAVE MUCH DIRECTION.

TED SIMONS: A FIVE YEAR LIFETIME CAP IF YOU TOOK THREE YEARS IN YOUR TWENTIES AND TWO YEARS IN YOUR THIRTIES NO MORE MEDICAID FOR YOU.

SWAPNA REDDY: TIMES UP.

TED SIMONS: WHAT HAPPENS AFTER FIVE YEARS?

SWAPNA REDDY: THAT'S A GREAT QUESTION. SO THE PURPOSE OF THE CAP IS THAT HOPEFULLY IN THOSE FIVE YEARS YOU HAVE BEEN INCENTIVIZED TO WORK AND NOT NEED MEDICAID ANYOMRE BUT IT BEGS THE QUESTION IF THAT DIDN'T HAPPEN. I THINK IT'S PART OF A LARGER NARRATIVE THAT THOSE ON MEDICAID IN THE UNITED STATES DOESN'T WORK BUT NOT NECESSARILY TRUE BECAUSE 60% OF THOSE ON MEDICAID IN THE UNITED STATES WORK. SO WE ARE NOT NECESSARILY TALKING ABOUT NO INCOME AMERICANS. WE ARE REALLY TALKING ABOUT VERY LOW INCOME AMERICANS.

TED SIMONS: I WAS GOING TO ASK BECAUSE IT SOUNDS LIKE THE WHOLE GOAL HERE IS TO ENCOURAGE ENROLLEES TO WORK.

SWAPNA REDDY: YES.

TED SIMONS: I GET THAT, I UNDERSTAND THAT BUT IT SOUNDS LIKE A LOT OF THESE FOLKS ARE WORKING OR HAVE TRIED TO WORK AND IT COMES AND IT GOES OR YOU CAN'T EVEN AFFORD IT EVEN THOUGH YOU HAVE A JOB AS YOU MENTIONED THE NARRATIVE IS KIND OF MOVES AROUND A LITTLE BIT HERE.

SWAPNA REDDY: ABSOLUTELY. SO WE KNOW 60% IN THE UNITED STATES DO WORK AND OF THE REST THAT ARE NOT WORKING WE HAVE A LOT OF FOLKS THAT ARE DISABLED. WE HAVE FOLKS THAT PERMANENTLY CARE FOR A LOVED ONE OR THAT ARE IN SCHOOL SO IT'S ACTUALLY A VERY SMALL PERCENTAGE OF THOSE ON MEDICAID THAT ARE SIMPLY NOT WORKING AND DON'T FALL IN ANY OF THE OTHER BUCKETS AS WELL.

TED SIMONS: AND AS YOU KIND OF REFERRED TO HERE MEDICAID IN MANY RESPECTS MAKES IT EASIER FOR PEOPLE TO WORK.

SWAPNA REDDY: ABSOLUTELY SO THIS IS AN INTERESTING NARRATIVE AND SEEMA VERMA, THE HEAD OF THE CMS, WROTE AN OP-ED THIS WEEKEND THAT HAS A LOT OF PLAY AND REALLY HER POSITION WAS THAT WHEN YOU ARE INCENTIVIZED TO WORK AND WHEN PEOPLE ARE ABLE TO WORK AND DO WORK THEY BECOME HEALTHIER. THEN, THERE’S A FLIP ARGUMENT YOU ACTUALLY NEED HEALTH TO BE ABLE TO WORK.

TED SIMONS: EXACTLY. YOU ALSO IF YOU'RE APPROACHING MEDICARE YOU ARE APPROACHING 65 LET'S SAY AND YOU'RE NEAR RETIREMENT YEARS AND LOSE YOUR JOB LET'S SAY YOU LOSE YOUR JOB.

SWAPNA REDDY: YES.

TED SIMONS: I MEAN YOU BETTER BE OVER THE AGE OF 60 RIGHT IF OR ELSE JUMP IN ANOTHER JOB OR THE CAP WILL HIT YOU AT 64, 63 AND GOOD LUCK FELLA.

SWAPNA REDDY: YEAH, ABSOLUTELY. WE DON’T HAVE A LOT OF DIRECTION HOW WE WILL DEAL WITH THIS WITH SENIORS AND THOSE WHAT WE ARE TALKING ABOUT ESPECIALLY OUR VULNERABLE SENIORS THOSE RIGHT THERE ON THE INCOME EDGE SO I THINK THAT THIS IS REALLY DISTURBING ON A LOT OF LEVELS AND I THINK THE NARRATIVE AND THE FACTS ARE NOT NECESSARILY ON THE SAME PAGE AT THE MOMENT.

TED SIMONS: IS THE GOAL HERE TO RECAST MEDICAID AS TEMPORARY ASSISTANCE?

SWAPNA REDDY: YES, SO THAT IS THE QUESTION RIGHT BECAUSE THE GOAL OF MEDICAID AS IT WAS WRITTEN SEVERAL DECADES AGO AND HOW IT'S BEEN ENFORCED ALL OF THESE YEARS IS TO REALLY INCREASE ACCESS AND COVERAGE FOR THE MOST VULNERABLE IN OUR POPULATION. SO THE QUESTION REALLY IS THAT WHAT WE WANT MEDICAID TO CONTINUE TO BE OR DO WE WANT TO COVER THE LEAST AMOUNT OF PEOPLE FOR THE LEAST AMOUNT OF MONEY, AND I THINK WHEN WE ARE LOOKING AT THESE POLICY PROPOSALS, IT'S REALLY IMPORTANT TO THINK ABOUT IT IN THOSE KIND OF TWO WAYS, WHAT IS OUR END GOAL HERE AND IF OUR END GOAL IS TO COVER THE LEAST AMOUNT OF PEOPLE FOR THE LEAST AMOUNT OF MONEY THESE PROPOSALS WILL GET US THERE.

TED SIMONS: ARIZONA TRIED FOR THIS FOR A NUMBER OF YEARS NOW THEY HAVE PRESIDENT TRUMP ADMINISTRATION THERE AND THAT SEEMS MUCH MORE LIKELY TO HAPPEN, HAS ANY OTHER STATES APPLYING FOR THIS, ANY OTHER STATES GETTING THROUGH?

SWAPNA REDDY: YES SO KENTUCKY AND INDIANA HAVE GOTTEN THROUGH AND KENTUCKY ALREADY THE WORK REQUIREMENT FOR THEIR MEDICAID WAIVER IS ALREADY IN FEDERAL COURT, THAT WAS BROUGHT BY 15 BENEFICIARIES WHO FELT IT WAS A GOVERNMENT OVER REACH AND IN PLACE IN INDIANA. WE HAVE 5-8 STATES THAT HAVE APPLIED BUT ALL EYES ARE ON STATES LIKE ARIZONA BECAUSE THEY THINK THOSE ARE THE NEXT ONES TO GET APPROVAL.

SWAPNA REDDY: THE SUIT IS GOVERNMENT OVER REACH ON A GOVERNMENT PROGRAM?

SWAPNA REDDY: YES.

TED SIMONS: THAT IS INTERESTING.

SWAPNA REDDY: VERY INTERESTING.

TED SIMONS: DO THE MATH ON THAT ONE. VERY INTERESTING. LET'S SAY ARIZONA SUCCEEDS AND GETS THROUGH, WHO PAYS FOR THE ADMINISTRATION AT THE STATE LEVEL? YOU GOT TO CHECK JOB STATUS YOU GOT TO CHECK CHILD CARE STATUS, OTHER BENEFITS, THESE SORTS OF THINGS.

SWAPNA REDDY: WELL AT THE MOMENT WE DON'T HAVE THE INFRASTRUCTURE OR THE FUNDS SET ASIDE TO ACTUALLY MINISTER WHAT IT WOULD TAKE TO KEEP ON TOP OF EXACTLY EVERYTHING YOU JUST SAID. SO YES THIS WOULD COST THE STATE MORE MONEY, WHAT WE DO KNOW IN ARIZONA IS WE HAVE ABOUT 1.9 MILLION PEOPLE ON MEDICAID. I MEAN WE HAVE LOTS OF FOLKS ON MEDICAID ABOUT QUARTER OF OUR POPULATION IS ON MEDICAID OR QUALIFIED FOR MEDICAID IN CHIP. SO IT'S NOT LIKE THIS IS JUST A SMALL AMOUNT OF OUR POPULATION. THESE ARE A LOT OF INDIVIDUALS. WE DON'T KNOW A LOT ABOUT HOW IT WOULD BE ADMINISTERED BUT WHAT WE DO KNOW FROM YEARS OF RUNNING MEDICAID AND CHIP IS WHEN YOU MAKE IT HARDER TO ENROLL YOU ACTUALLY LOSE COVERAGE. WHEN YOU STREAM LINE AND MAKE IT EASIER TO ENROLL YOU INCREASE COVERAGE, SO THAT GOES BACK TO OUR QUESTION IS THAT OUR GOAL IS THAT NOT OUR GOAL.

TED SIMONS: INDEED AND AS FAR AS THE MONEY I THINK I CHECKED THE MONEY AS YOU REFERRED TO AGAIN EARLIER AFTER FIVE YEARS THESE FOLKS ARE GOING TO WIND UP GOING TO HOSPITAL EMERGENCY ROOMS. THIS IS WHAT THE WHOLE MEDICAID EXPANSION ARGUMENT WAS ABOUT IN THE FIRST PLACE.

SWAPNA REDDY: YEAH, ABSOLUTELY. WITH THE MEDICAID EXPANSION WE HAVE 400,000 ADULTS THAT JOINED THE MEDICAID ROLLS AND CONTRIBUTE TO THAT 1.9 MILLION DOLLARS. YOU ARE RIGHT, ONCE THOSE FIVE YEARS ARE OVER AND LET'S SAY YOU ARE NOT IN A POSITION WHERE YOU CAN AFFORD YOUR OWN HEALTHCARE AND YOU CAN GET IN THE PRIVATE MARKET, WELL WHAT HAPPENS TO YOU, YOU DON'T DISAPPEAR SO WE KNOW FROM PREVIOUS WHAT WE KNOW FROM HISTORY IS YOU WILL GO BACK TO THE EMERGENCY ROOM AND GO BACK TO OUR PREVIOUS SAFETY NET SO WHICH ONE IS CHEAPER AND WHICH IS MORE EXPENSIVE.

TED SIMONS: CHEAPER NOT ONLY FOR THE STATE BUT CHEAPER FOR OTHER FOLKS GOING AND GETTING HEALTH SERVICES.

SWAPNA REDDY: ABSOLUTELY.

TED SIMONS: OBVIOUSLY THE TRUMP ADMINISTRATION SEEMS SYMPATHETIC TO THIS BUT DO WE KNOW FOR SURE THIS IS THE KIND OF THING THAT WILL JUST GLIDE ON THROUGH? IS THERE PUSH BACK FROM THE ADMINISTRATION OR SOME SORT OF YOU KNOW MOVING AROUND OF IDEAS AND VARIABLES INVOLVED?

SWAPNA REDDY: WELL WE HAVE NOT HEARD MUCH FROM THE ADMINISTRATION BUT WHAT WE DID RECEIVE LIKE I MENTIONED IS THE OP-ED PIECE FROM SEEMA VERMA THIS LAST WEEKEND SO THAT REALLY SEEMS TO BE A BIG ENDORSEMENT THAT THIS IS WHAT CMS WANTS TO SEE STATES DO. AND SO WHILE WE HAVE NOT GOTTEN A DEFINITIVE ANSWER IT SEEMS FAIRLY FAVORABLE.

TED SIMONS: YEAH SO WHAT IS NEXT, WHAT IS THE TIMETABLE?

SWAPNA REDDY: WE DON'T KNOW. THE REALITY IS WE DON'T KNOW. IT'S IMPENDING SO THE ANSWER IS ON THESE ON THESE WAIVER PROPOSALS ARE IMPENDING AND IT COULD BE VERY VERY SOON.

TED SIMONS: ONE LAST QUESTION ON THIS I THOUGHT DOING PREVIOUS STORIES ON THIS THAT IF YOU GOT A WAIVER AND YOU APPLIED FOR A WAIVER A CHANGE FROM THE FEDERAL GOVERNMENT YOU MUST ALSO PROVE THAT YOUR WAIVER FURTHERS MEDICAID'S OBJECTIVES. HOW DOES THIS OR HOW WOULD THIS FURTHER MEDICAID'S OBJECTIVES?

SWAPNA REDDY: GREAT QUESTION BECAUSE THE OBJECTIVE WE ARE FAMILIAR WITH IS THAT INCREASING COVERAGE INCREASING ACCESS OBJECTIVE. BUT YOU KNOW THERE IS A NARRATIVE AND THERE IS A SCHOOL OF THOUGHT THAT REALLY SAYS THAT WHEN WE ENCOURAGE THOSE TO WORK WE ACTUALLY ENABLE THOSE TO BECOME HEALTHIER AND SEEK COVERAGE AND HAVE COVERAGE THROUGH OTHER FORMS AS WELL SO THERE IS REALLY KIND OF DIFFERENT SCHOOLS OF THOUGHT HOW WE ARE LOOKING AT THIS.

TED SIMONS: DO YOU THINK THE STATE IS READY FOR IN THE EXTENT AND THE WHOLE BUREAUCRACY INVOLVED.

SWAPNA REDDY: IT'S HARD TO SAY. I DON'T SEE WE’VE CREATED A SYSTEM THAT IS READY FOR THIS AT ALL AND WHAT WE DO KNOW FOR A FACT THOUGH IS WE HAVE LOTS OF PEOPLE THAT DEPEND ON THIS FOR THEIR HEALTHCARE EVERYDAY.

TED SIMONS: GREAT INFORMATION GOOD TO HAVE YOU HERE THANKS FOR JOINING US.

SWAPNA REDDY: THANKS FOR HAVING ME.

TED SIMONS: AND UP NEXT, WE WILL HEAR ABOUT ARIZONA THEATRE COMPANY'S LATEST PRODUCTION OUTSIDE MULLINGAR.

Swapna Reddy: ASU School for the Science of Health Care Delivery

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