Dr. Oz finally released the details of the new Medicaid work and community engagement requirements for Medicaid members in the ‘expansion population’.
The new rules apply to people 19-64 with incomes between 100 and 138% of poverty. Starting January (or more accurately at their 1st redetermination date after January 1).
Members in the expansion population who aren’t exempt will need to prove they have at least 80 hours of approved activities. People subject to the requirement can meet the requirement by working, taking part in a job-training program, volunteering in their community or combining these activities.
The rules are scheduled to begin on January 1, 2027. For people who are already enrolled in AHCCCS, the new requirement will generally begin with the first regularly scheduled renewal process started on or after that date.
New applicants will need to show that they met the requirement for at least one month before applying.
One of the main things the new rules do is define who’s exempt. Included in the list last week are pregnant women, people receiving postpartum coverage, former foster youth, American Indians, certain caregivers, totally disabled veterans, people taking part in drug or alcohol treatment programs and people who are medically frail.
The biggest risk in terms of who will get kicked off Medicaid next year isn’t that people will no longer qualify because they don’t meet the new criteria. The big problem is likely to be that people won’t be able to navigate the system to prove they meet the requirements (and Congress new that).
AHCCCS is supposed to use information already available to the government before asking members to submit more paperwork. When AHCCCS can’t confirm that a person meets the requirement or qualifies for an exemption, they need to send the member a notice. The member will then have 30 days to respond before losing coverage.
The Health-e-Arizona Plus website a big part of the story. The portal should be easy to use, easy to understand and easy to navigate on a phone. Notices must be clear. Customer-service staff must be available to help.
The thing is that Health-e-Arizona (AHCCCS’ portal to report compliance) isn’t easy to use right now. If AHCCCS doesn’t fix it in the next few months lots of people who actually meet the work requirements won’t be able to prove it and will lose coverage.
Arizona’s SNAP Eligibility Collapses, Signaling Big Administrative Problems at ADES
Thousands of people lost SNAP food assistance because of administrative errors at the agency level (ADES) and the clunky Health-e-Arizona plus computer portal.
That’s our call to action for them.
