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031511-ahcccs-summary

031511-ahcccs-summary

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Published by: julie_rose3104 on Mar 16, 2011
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03/16/2011

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State of Arizona Proposed Medicaid Reform Plan
1
ProposalGeneral Fundsavings Timing Action required Details
Medicaid Eligibility 
Eliminate enrollment of childless adults$190 M July 1, 2011 In order to implement priorto Oct. 1, 2011, requiresmaintenance-of-effort waiverfrom the federal Centers forMedicare and MedicaidServices (CMS).(Implementation after Oct. 1requires CMS approval of new demonstration project.)No new childless adults may enroll, andexisting members who lose coverage maynot re-enroll. Proposal continuescoverage for childless adults alreadyenrolled in the Arizona Health Care CostContainment System (AHCCCS) as of June30, 2011.Eliminate “spenddown” program$70 M May 1, 2011(begin freeze);Oct. 1, 2011(eliminated)Submit phase-down plan toCMS by April 1, 2011.Requires CMS approval of phase down plan by May 1,and approval of newdemonstration project bySept. 30, 2011
1
 “Spend down” refers to people whowould ordinarily not qualify for AHCCCSbut who have sustained medical expensesthat reduced their income to below 40%of the Federal Poverty Level (FPL).Currently, “spend down” eligibility is 6months in duration. Thus, a 6-monthfreeze will result in full phase-out byOctober 1.
1
Section 1115 of the Social Security Act provides the U.S. Secretary of Health and Human Services broad authority to authorize “demonstration projects” likely to assistin promoting Medicaid objectives. Section 1115 allows the Secretary to waive certain Medicaid requirements, and to provide federal matching monies for costs that arenot typically permitted to be paid for with Medicaid funding. AHCCCS has operated as a demonstration project under Section 1115 authority since its inception.http://www.cms.gov/MedicaidStWaivProgDemoPGI/03_Research&DemonstrationProjects-Section1115.asp 
 
State of Arizona Proposed Medicaid Reform Plan
2
ProposalGeneral Fundsavings Timing Action required Details
Eliminate enrollment of parents earning 75 -100% of FPL$17 M Oct. 1, 2011 Requires maintenance-of-effort waiver from CMS.No new enrollment of parents earningabove 75% of FPL. Coverage continuesfor parents above 75% of FPL who arealready enrolled as of September 30,2011. No change in coverage for parentsearning below 75% of FPL.Eliminate FederalEmergency Services(for non-qualifiedaliens)
2
 $20 M To BeDeterminedWill request under newdemonstration project butmay require federal lawchange.Eliminates Medicaid reimbursement foremergency care given to non-qualifiedaliens.Require 6-monthredetermination of eligibility for currentenrollees$15 M Oct. 1, 2011 Requires maintenance-of-effort waiver from CMS; alsorequires demonstrationproject approval for childlessadults and state planamendment for parents.Mandates that childless adults andparents re-qualify for AHCCCS every sixmonths (rather than annually).
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A definition of a “qualified alien” can be found here: https://www.cms.gov/MedicaidEligibility/downloads/alien1.pdf 
 
State of Arizona Proposed Medicaid Reform Plan
3
ProposalGeneral Fundsavings Timing Action required Details
Personal Responsibility 
Expand mandatory co-payments for parents$2.7 M Oct.1, 2011 Requires CMS approval of new demonstration project.Set co-payments same as transitionalmedical assistance (TMA) population, plusnon-emergency use of an emergencydepartment.
3
 Expand mandatory co-payments for childrenTo Be Determined Oct. 1, 2011 Requires CMS approval of new demonstration project.Set co-payments same as TMApopulation, plus non-emergency use of anemergency department; some exceptions(e.g., drugs for chronic conditions such asasthma). AHCCCS will develop list of exceptions. Exploring opportunities tolink wellness/healthy behavior incentivesto copayments (see
Wellness Efforts)
.Institute “no-show”penalty for missedappointments$0 for the state;TBD for healthprovidersOct. 1, 2011 Requires CMS approval of new demonstration project.Modeled after no-show penalties chargedby private insurer.
Benefit Reforms
Impose new benefitlimits$40 M Oct. 1, 2011 State Plan Amendment Institute 25-day hospital inpatient limitfor adults.Institute office visit limit for childlessadults and parents.
3
Information on current copayment levels can be found here:http://www.azahcccs.gov/members/copayments.aspx 

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