Back in 2015, the Arizona Legislature passed & Governor Ducey signed SB1092, mandating that AHCCCS ask for federal approval to limit lifetime eligibility to 5 years for all ‘able-bodied’ adults (regardless of income).
The law also requires them to ask permission to implement work requirements for all “able-bodied adults” receiving Medicaid.
AHCCCS is supposed send their request to CMS each April. AHCCCS first submitted the plan and got the green light back in 2019 – but they didn’t implement it because of an ongoing court case challenging the legality of the plan.
The COVID-19 Public Health Emergency put things on hold throughout the rest of 2020. In February 2021, the Biden Administration’s CMS rescinded approval for the AHCCCS Works program.
As April approaches, AHCCCS is getting ready to submit the request again – and launched their draft proposal, which they plan to submit to CMS in a couple of months.
What they put in their final plan is super important as Dr Oz (the CMS Administrator) is certain to approve the plan (unless he thinks it’s not harsh enough).
According to the draft plan released this week, able bodied adults can be exempt from the work requirements by doing the following things for at least 20 hours per week:
- Be employed;
- Attend school; or
- Attend an Employment Support programs like:
- English as a 2nd language courses;
- Parenting classes;
- Disease management education;
- Courses on health insurance competency; and/or
- Healthy living classes.
Not everyone will be subject to these proposed rules (including the 5-year lifetime limits on eligibility) as AHCCCS’ draft proposal exempts the following populations from the definition of ‘able bodied’:
- People over 55
- American Indians
- Pregnant women up to 90 – 120 days post-delivery
- Former foster youths up to age 26
- People with a serious mental illness
- Those receiving temporary or permanent long-term disability benefits
- Individuals deemed medically frail
- Full-time students in high school, college, or graduate school
- Victims of domestic violence
- Individuals experiencing homelessness
- Those recently affected by certain events (e.g. death of a household family member)
- Parents, caretaker relatives, foster parents, and caregivers of family members enrolled in the Arizona Long Term Care System
AHCCCS wants to hear from you about their draft proposal. They’re encouraging the public to review the proposal and share their thoughts.
You can send your comments via email to [email protected]. There are also some public forums about their proposal at AHCCCS Works 1115 Waiver Amendment Request.
Please take some time to look at their proposal and let them know if you have ideas to make it more palatable. All comments are due by March 20, 2025.
Remember – it’s still important to comment if you think AHCCCS has done a good job identifying the exempt populations and providing a broad interpretation of how members can meet the work (community engagement) requirements!
Editorial Note: How AHCCCS implements the program will be critical to minimizing the number of people who are thrown off of AHCCCS coverage once this is approved and implemented.
In other states that have implemented a similar work requirement lots of people met the community engagement/work requirements but weren’t able to successfully document their service or work – or didn’t know how to – and were thrown off Medicaid even though they were doing what was required of them.
