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ARIZONA HOUSE OF REPRESENTATIVESFifty-seventh Legislature First Regular Session |
House: APPROP DPA/SE 10-8-0-0 |
HB 2926: TPT reimbursement; residential development
S/E: AHCCCS; eligibility
Sponsor: Representative Carbone, LD 25
Caucus & COW
Summary of the Strike-Everything Amendment to HB 2926
Specifies that if the state's federal match rate for the Medicaid expansion population drops below 90%, rather than 80%, then the Arizona Health Care Cost Containment System (AHCCCS) must discontinue eligibility for those eligible persons. Outlines conditions that must be met for AHCCCS to continue eligibility for persons covered under the Medicaid expansion.
History
Established in 1981, AHCCCS is Arizona's Medicaid program. It is a federal health care program jointly funded by the federal and state government that oversees contracted health plans for the delivery of health care services to individuals and families who qualify for Medicaid and other medical assistance programs. Through its contracted health plans, AHCCCS delivers health care to qualifying individuals including low-income adults, their children or people with certain disabilities. Current statute outlines covered health and medical services offered to AHCCCS members (A.R.S. § 36-2907).
The Section 1115 Waiver refers to section 1115 of the federal Social Security Act (SSA). States are required to comply with Title XIX (Medicaid) and Title XXI (Children’s Health Insurance Program) of the SSA. AHCCCS has been operating under an 1115 Research and Demonstration Waiver that exempts AHCCCS from certain provisions of the SSA. Any modification to the waiver must be submitted and approved by the Centers for Medicare and Medicaid Services (CMS).
The Affordable Care Act (ACA) was passed by Congress in March 2010. The ACA expanded access to health insurance to various groups of the uninsured. It extended Medicaid eligibility to individuals up to 133% of the federal poverty level (FPL) (Medicaid expansion population).
Laws 2013, First Special Session, Chapter 10 included provisions relating to the expansion of Medicaid. Included in the expansion is the increase in the income eligibility level for all children up to 133% FPL, childless adults up to 100% FPL and adults up to 133% FPL, instituting a hospital assessment for the benefit of providing health care for eligible persons, the requirement that AHCCCS pursue cost sharing requirements for members, a hospital transparency report, a notice to AHCCCS members that their enrollment may depend on federal financial participation and other provisions related to the expansion.
The Hospital Assessment Fund is an assessment on hospital revenues, discharges or beds days. The purpose of the fund is to cover the non-federal share of Proposition 204 services and the adult population who became eligible for AHCCCS services on January 1, 2014.
AHCCCS is required to discontinue eligibility for the Medicaid expansion population and the Hospital Assessment if any of the following occur: 1) the federal matching rate for adults in this category or childless adults falls below 80%; 2) the maximum amount that can be generated from the hospital assessment is insufficient to pay for the newly eligible populations; or 3) the ACA is repealed.
Provisions
1. Requires AHCCCS to discontinue eligibility for persons under 65 years of age whose household's modified adjusted gross income is more than 100% but equal to or less than 133% FPL if the federal medical assistance percentage (FMAP) is less than 90%, rather than 80%. (Sec. 1)
2. Requires AHCCCS to discontinue eligibility for persons under 65 years of age whose household's modified adjusted gross income is more than 100% but equal to or less than 133% FPL if any of the following is not met by the administration:
a) has implemented a work requirement for able-bodied adults who are enrolled in the system in which a person is not eligible to participate in the system unless the person meets the listed exceptions;
b) has maintained a Medicaid improper payment rate of 5% or less;
c) has suspended requirements, with federal approval, if necessary, to automatically renew eligibility based on available information and use pre-populated forms;
d) has received an approved waiver and implemented a lifetime benefit limit of 60 months for able-bodied adults, counting only time spent in that eligibility category;
e) has implemented, with federal approval, if necessary, biannual redeterminations for persons who are eligible under federal law;
f) has limited, with federal approval, if necessary, hospital presumptive eligibility determinations to children and pregnant women. (Sec. 1)
3. Directs AHCCCS to implement an able-bodied work requirement in which a person is not eligible to participate in the system unless the person:
a) works at least 20 hours per week, averaged monthly;
b) participates and complies with the work program requirements of at least 20 hours per week, as determined by AHCCCS;
c) volunteers at least 20 hours per week, as determined by AHCCCS;
d) meets any combination of working and participating in a work program for at least 20 hours per week, as determined by AHCCCS; or
e) participates and complies with the workfare program requirements unless the person meets any of the listed exemptions. (Sec. 1)
4. Excludes the following populations from participating and complying with the workfare program requirements:
a) a person under 19 years of age;
b) a person at least 64 years of age;
c) a person who is pregnant;
d) a person who is medically certified as physically or mentally unfit for employment;
e) a parent or caretaker who is responsible for the care of a dependent child who is under six years of age;
f) a parent or caretaker who is personally providing the care for a dependent child who has a serious medical condition or disability, as determined by AHCCCS;
g) a person who participates in a drug addiction or alcohol treatment and rehabilitation program; or
h) a person who receives unemployment compensation and complying with work requirements that are part of the federal-state unemployment compensation system. (Sec. 1)
5. Requires AHCCCS to provide to the Senate and House of Representatives Health and Human Services (HHS) Committees or their successor committees every two years for review data provided by AHCCCS to CMS that demonstrates its Medicaid improper payment rate for the preceding two years. (Sec. 1)
6. Requires AHCCCS to submit any necessary amendments or waivers to the current Section 1115 waiver to CMS no later than 90 days after October 1, 2025, to implement these requirements. (Sec. 1)
7. Requires AHCCCS to take all actions necessary to implement the requirements as practicable. (Sec. 1)
8. Requires AHCCCS to notify the Senate and House of Representatives HHS Committees, or their successor committees, within 30 days after the submission, approval, rejection or withdrawal of any federal amendment, waiver request or state plan amendment submitted to carry out these requirements. (Sec. 1)
9. Requires AHCCCS to terminate eligibility for eligible persons no later than January 1, 2027, if any conditions required for eligibility are not met before 90 days after April 1, 2026. (Sec. 1)
10. Requires AHCCCS to terminate eligibility for eligible persons within 90 days after the date the conditions are not met if all conditions required for eligibility are met within 90 days after April 1, 2026, but are not met at any point thereafter. (Sec. 1)
11. Prohibits AHCCCS from collecting an assessment for costs associated with service after the effective date of any reduction of the FMAP that is less than 90%, rather than 80%. (Sec. 2)
12. Conditions, as session law, the repeal of Medicaid expansion and the hospital assessment if the FMAP falls below 90%, rather than 80%. (Sec. 3)
13. Requires the AHCCCS Director to notify the Director of Legislative Council if the FMAP drops below 90%, rather than 80%. (Sec. 3)
14. Makes technical changes. (Sec. 1 and 3)
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18. HB 2926
19. Initials AG Page 0 Caucus & COW
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