ARIZONA STATE SENATE
Phoenix, Arizona
REVISED
Purpose
Expands, beginning on
January 1, 2002 and subject to HCFA approval, coverage under the Arizona Health
Care Cost Containment System (AHCCCS) and Arizona long term care system (ALTCS)
to include persons who due to their disabilities are eligible for Supplemental
Security Income (SSI) or Social Security Disability Insurance (SSDI) and whose adjusted
income does not exceed 250 percent of the federal poverty level (FPL). Appropriates $591,000 in FY 2001-2002 and
$1,000,000 in FY 2002-2003 to cover this new eligible population.
Background
Through the Balanced Budget
Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999,
states have the option of extending Medicaid coverage to working people with
disabilities whose incomes from work previously would have disqualified them
from coverage. Under this option,
states may elect to create an eligibility category through which SSI and SSDI
recipients and other disabled persons can work and “buy-in” to Medicaid
coverage by paying premiums, thus maintaining their long-term supports and
services. In addition, states may
establish income and asset guidelines and implement copayments, fees or other
cost sharing for participants. When a
state establishes a Medicaid buy-in program, it creates a Medicaid entitlement
that serves as a supplement to any income and health benefits a person obtains
from being employed. To implement
Medicaid buy-in programs, a state must submit a Medicaid state plan amendment
that describes the income, resource and cost-sharing policies for the eligible
group. According to the National State
Conference of Legislatures, as of August 2000, 18 states have implemented or
are in the process of implementing Medicaid buy-in programs for working people
with disabilities.
According to the AHCCCS
administration, there are approximately 141,600 Arizonans who receive SSI or
SSDI. Based on the number of buy-in
participants in other states, the administration estimates a potential 708
persons are eligible under the buy-in option at 250 percent FPL; 531 of whom
are currently enrolled in AHCCCS. The
remaining 177 individuals are new eligibles, 106 of whom need acute care
services and 71 of whom need long term care services.
S.B. 1291 establishes, as of
January 1, 2002, a Medicaid buy-in category under AHCCCS for both the acute
care program and the long term care program for people who due to their
disabilities are eligible for SSI or SSDI benefits and whose income does not
exceed 250 percent FPL. To cover the
state’s share of this newly eligible Medicaid population, S.B. 1291 appropriates
$591,000 in FY 2001-2002 and $1,000,000 in FY 2002-2003 from the state general
fund to AHCCCS.
Provisions
1. Expands, beginning on January 1, 2002 and subject to HCFA approval, AHCCCS and ALTCS coverage to include persons who due to their disabilities are eligible for SSI or SSDI and whose adjusted income is at or below 250 percent FPL.
2. Excludes, from a person’s income for the purpose of determining eligibility, the person’s unearned income, a spouse’s income and the costs of impairment-related work expenses (such as attendant care services and medical devices).
3. Requires the administration to adopt rules for the collection of premiums.
4. Limits the collection of premiums to two percent of the person’s adjusted income.
5. Requires the administration to develop and implement a process for determining: eligibility, annual re-determinations and medically improved disabilities.
6. Authorizes the administration to enter into intergovernmental agreements with the Department of Economic Security, a county or health plan to conduct eligibility determinations and re-determinations.
7. Prohibits the administration from using a resource test.
8. Requires the administration to submit a report regarding services to the new population to the Legislature by December 31, 2002.
9. Exempts the administration from the formal rule making requirements for one year from the effective date of this act and requires the administration to provide the public with two opportunities to comment on proposed rules.
10. Appropriates $591,000 in FY 2001-2002 and $1,000,000 in FY 2002-2003 from the state general fund to AHCCCS to cover this new population.
11. Prohibits the State Treasurer from releasing the appropriation until HCFA approves a waiver for this option.
12. Makes technical changes.
13. Provides for a general effective date except as noted.
Amendments Adopted by Appropriations Committee
1. Reduces the eligibility threshold from 400 percent FPL to 250 percent FPL.
2. Eliminates the requirement of the administration to apply for the waiver by October 1, 2001.
3. Reduces the FY 2001-2002 appropriation from $831,000 to $591,000.
4. Increases the FY 2002-2003 appropriation from $914,000 to $1,000,000.
5. Adds the reporting requirement.
6. Eliminates the exemption from lapsing for the appropriations.
7. Makes clarifying and conforming changes.
Senate Action
HEA 2/6/01 DP 6-0-2-0
APPROP 2/27/01 DPA 12-0-0-0
Prepared by Senate Staff
February 28, 2001