CMS Approves Arizona Waiver Request
On Friday, January 18, 2019, CMS approved Arizona’s 1115 waiver request to amend their Medicaid project, the Arizona Health Care Cost Containment System (AHCCCS), to include a community engagement requirement, better known nation-wide as a work requirement.
The waiver amendment will require individuals aged 19 through 49 to: 1) participate in community engagement activities for at least 80 hours a month, and 2) report their activities on a monthly basis. Approved community engagement activities include employment (including self-employment), employment readiness activities (like education, job or life skills training, and health education classes), job search activities, and community service.
The Arizona waiver is the first to include an exemption for members of federally recognized Native American tribes. CMS worked with state and tribal leadership to address their concerns with implementing the amendment and to allow the state flexibility necessary to tailor their program to the state’s population. CMS stated it believed the exemption was consistent with the tribes’ status as political entities.
Exemptions will also be allowed for pregnant and post-partum women, former foster youth up to age 26, beneficiaries with serious mental illness, those receiving temporary or long-term disability benefits, the medically frail, those in active treatment for substance use disorder, individuals enrolled in full time school, and the homeless, among others.
There will be a three month grace period for enrollees to meet the requirements once they are determined to be eligible for the program. Failure to meet the requirements or report compliance during any time after the three month grace period will result in suspension of the enrollee’s benefits for two months. Their eligibility will be reactivated immediately after the suspension if they continue to meet all other eligibility criteria. The community engagement requirement may not begin sooner than January 1, 2020. CMS did not approve Arizona’s request to implement a five-year maximum lifetime limit for beneficiaries that fail to comply with the community engagement requirements.
Additionally, the waiver allows for the removal of the three month retroactive eligibility period to allow Arizona to “test whether waiving retroactive coverage for certain groups of Medicaid beneficiaries encourages them to obtain and maintain health coverage, even when healthy, or to obtain health coverage as soon as possible after becoming eligible.” Beginning no sooner than April 1, 2019, Arizona will instead be allowed to grant eligibility to AHCCCS enrollees beginning in the month in which they submit an application for coverage. Pregnant women, women who are 60 days or less postpartum, infants under 1 year of age, and children under age 19 are exempt from the retroactive eligibility waiver.
Maine Withdraws Previously Submitted and Approved Waiver
On January 22, 2018, Governor Janet Mills withdrew Maine from their previously submitted and approved Medicaid waiver request that would have implemented work requirements and monthly premiums for enrollees. Mills sent a letter to Seema Verma, the Administrator of CMS, stating that Maine would not accept the waiver terms, as they “would leave more Maine people uninsured without improving their participation in the workforce.” The waiver would have implemented 80 hours of work of community engagement activities a month and up to $40 per month in premiums.
The waiver was pushed for by prior Republican Governor Paul LePage and approved in December shortly LePage’s term expired. Mills has spent her short time in office working to expand Medicaid, a voter-approved measure that was prevented from being implemented by LePage. Additionally, the Mills administration has pledged to expand various programs for those receiving public assistance, including increasing the number of individuals who participate in work programs through the TANF and food stamp programs.
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