Arizona is trying again to get the federal government to approve a work requirement for some able-bodied adults in the state's Medicaid program.
The requested waiver from federal Medicaid rules outlined Thursday by Republican Gov. Doug Ducey's health care policy adviser comes a year after the Obama Administration rejected work requirements.
Other key changes Christina Corieri outlined include limits on non-emergency medical transportation in urban areas, cuts to retroactive coverage and limiting access to some drugs. Also included is a five-year lifetime limit on coverage for those who fail to meet the work requirements.
The changes will be requested in a formal waiver request to the Trump administration next month.
The new administration has urged states to consider changes to their state Medicaid programs to encourage work and independence. Seema Verma, who runs the Center for Medicare and Medicaid Services, sent a letter to governors in March urging them to roll back some of the new coverage available under the Affordable Care Act.
"The expansion of Medicaid through the Affordable Care Act to non-disabled, working age adults without dependent children was a clear departure from the core, historical mission of the program," Verma wrote in the letter, which was also signed by then Health and Human Services Secretary Tom Price.
She said much higher federal payments for the expansion population put upward pressure on state and federal spending and gave states "an incentive to deprioritize the most vulnerable populations."
A growing number of mainly Republican-led states have asked for work requirements or other waivers to Obama-era Medicaid rolls. Work requirement requests are pending for Arkansas, Indiana, Kentucky, Maine, Wisconsin, New Hampshire and Utah. Ohio and Kansas also plan to ask for work requirements.
The Obama administration last year approved some changes to Arizona's Medicaid program, including allowing some co-pays and premiums. But they rejected more controversial provisions that would have required them to get a job and be phased out of the system after five years.
The new waiver will also include a five-year limit, but its use would essentially be limited to people who refused to enter the workforce or a training program. The work requirement won't apply to people in school or other training programs, and could be met through 20 hours of work. Recent prison inmates and some selected people who are hard to employ or community service
Corieri said there isn't an estimate on the cost savings, but said the work requirement would eventually lead to fewer people needing Medicaid, known in Arizona as the Arizona Health Care Cost Containment system, or AHCCCS.
"The point is to not remove from AHCCCS but to help get them to a point where they no longer need AHCCCS because they have employment," Corieri said.
The work requirement drew criticism from Jessica Schubel, a former Obama administration official who worked on Arizona's previous waiver and now is a senior policy analyst with the left-leaning Center on Budget and Policy Priorities.
She said she expects a lawsuit when the Trump administration approves work requirements because they are not allowed under the Medicaid waiver law. She said the vast majority of people able to work already do.
"Conditioning Medicaid eligibility through work requirements does not further the purpose of the Medicaid program," Schubel said. "Medicaid is providing health insurance to people, it's not about requiring work."
She also said the change from 90 days retroactive coverage to 30 days will hurt the elderly and others who go into nursing homes. She said Iowa is starting to see that problem under a recently approved waiver, with nursing homes refusing to take patients.
The cuts to non-emergency medical transportation would only apply to those able-bodied adults in the expanded coverage population, those who earn between 100 percent and 138 percent of the federal poverty limit. Corieri didn't have an estimated number of people affected.