ARIZONA STATE SENATE
Phoenix, Arizona
REVISED
AHCCCS; eligibility;
programs
Purpose
Continues the Arizona Health
Care Cost Containment System (AHCCCS) premium sharing demonstration project as
a permanent, statewide program.
Appropriates medically needy account monies to expand AHCCCS coverage
for certain persons with disabilities, critical access hospitals and Healthcare
Group. Makes programmatic changes to
the children’s health insurance program.
Background
Laws 1996, Chapter 368
created a three-year premium sharing program to provide uninsured individuals
access to health care insurance. The
legislation also established the AHCCCS Premium Sharing Demonstration Project
Implementation Committee to make recommendations regarding eligibility, cost
sharing and a services package for the program.
The Legislature adopted the
Committee’s recommendations (Laws 1997, Chapter 186), enabling the AHCCCS
administration to establish the program in four counties for low income
families who do not qualify for AHCCCS, but who have a household income of less
than 200 percent of the federal poverty level (FPL), to obtain low cost health
insurance. The program is also
authorized to enroll 200 chronically ill individuals who have been enrolled in
the Medically Needy/Medically Indigent (MN/MI) program for 12 consecutive
months preceding enrollment and whose incomes do not exceed 400 percent
FPL. (The MN/MI program is being phased
out due to Proposition 204.)
The program was implemented
on February 1, 1998 in Cochise, Maricopa, Pima and Pinal counties and is
supported by $20 million of tobacco tax revenue in each of the program’s three
years. As of March 3, 2001, 7,596 individuals
from almost 5,650 households were enrolled with the program, including 169
chronically ill persons under 200 percent FPL and 14 between 200 and 400
percent FPL. The administration
estimates the program could serve between 5,000 and 7,000 individuals based on
current capitation rates, and receives a high level of interest in the program
from constituents in counties other than the four selected for the program,
such as Coconino, Yavapai and Yuma.
H.B. 2585 continues and expands the demonstration project as the premium
sharing program (PSP) on a permanent, statewide basis. In addition, the bill requires AHCCCS to
seek a waiver from the U.S. Health Care Financing Administration (HCFA) to
provide coverage to parents of children who are eligible for the children’s
health insurance program (CHIP). If
approved, the administration estimates – at an 80 percent presentation rate –
25,000 to 26,000 parents could receive coverage under the waiver.
In
addition, this legislation contains provisions from several other measures
including S.B. 1074 (children’s health insurance; requirements; study), S.B.
1075 (children’s health insurance; hardship exceptions), S.B. 1079
(appropriation; AHCCCS; critical access hospitals) and H.B. 2245 (AHCCCS;
disabilities; eligibility.).
Provisions
Premium Sharing Program
1. Continues and expands, beginning September 30, 2001, the premium sharing demonstration project as the PSP on a permanent, statewide basis.
2. Increases, from 200 percent FPL to 250 percent FPL, the income eligibility threshold for persons who do not have a specific chronic disease.
3. Increases the cap on the premium from four percent to six percent of the enrollee’s household gross income.
4. Eliminates the requirement of PSP to use Healthcare Group (HCG) health plans.
5. Appropriates $5 million in FY 2001-2002 from the medically needy account to AHCCCS for PSP.
6. Appropriates, beginning on July 1, 2002, $26.2 million annually from the medically needy account to AHCCCS for PSP.
7. Appropriates $6 million in FY 2001-2002 from the medically needy account to AHCCCS to offset losses associated with HCG.
8. Expands the source of monies for the premium sharing program fund to include tobacco litigation settlement monies that are designated for the program.
9. Requires the administration to use up to one-half of one percent ($140,000) of the annual appropriation on marketing and outreach.
10. Requires the administration to request a waiver from HCFA to provide coverage to parents of children who are eligible for CHIP.
11. Requires AHCCCS to use PSP monies to pay for the state’s share of coverage for CHIP parents.
12. Requires the AHCCCS Director to establish a uniform application and eligibility process and coordinate screening for PSP, HCG and CHIP.
13. Requires the administration to establish copayments for services. Maintains current enrollee copayments until November 15, 2001.
14. Requires the administration to define “chronic disease.” Maintains the current definition for “chronic disease” until the administration adopts a definition.
15. Continues the Premium Sharing Program Oversight Committee and the semiannual reporting requirement regarding the implementation and operation of PSP.
16. Exempts the administration from the rule making process for one year to implement PSP.
17. Requires the administration to report to the Premium Sharing Program Oversight Committee and conduct at least two public hearings before adopting the rules.
18. Requires the administration to publish adopted rules.
19. Terminates PSP on July 1, 2010.
20. Repeals the definition of “chronic disease” on November 15, 2001.
Critical Access Hospitals
21. Appropriates $800,000 from the state general fund and $900,000 of federal matching monies in FY 2001-2002 and FY 2002-2003 to AHCCCS to facilitate increased reimbursement for small rural hospitals designated as critical access hospitals
Ticket to Work
22. Expands, beginning on January 1, 2002 and subject to HCFA approval, AHCCCS and Arizona long term care system coverage 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 is at or below 250 percent FPL.
23. 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).
24. Requires the administration to adopt rules for the collection of premiums.
25. Limits the collection of premiums to two percent of the person’s adjusted income.
26. Requires the administration to develop and implement a process for determining: eligibility, annual re-determinations and medically improved disabilities.
27. 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.
28. Prohibits the administration from using a resource test.
29. Requires the administration to submit a report regarding services to the new population to the Legislature by December 31, 2002.
30. 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.
31. 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.
32. Prohibits the State Treasurer from releasing the appropriation until HCFA approves a waiver for this option.
Children’s Health Insurance Program
33. Requires the AHCCCS Director to prescribe the circumstances to grant a hardship exemption to the disenrollment requirements for a member who is not able to pay the premiums under CHIP.
34. Eliminates the required six-month waiting period for eligibility when a child’s health insurance coverage is voluntarily dropped.
35. Allows the Director of AHCCCS to adopt rules that require a time period during which a child who voluntarily discontinues insurance coverage must remain uninsured.
Miscellaneous
36. Makes numerous conforming and technical changes.
37. Provides for a general effective date, except as noted.
Amendments Adopted by Health Committee
1.
Reduces
the FY 2001-2002 appropriation for PSP from $28 million to $5 million.
2.
Reduces
the annual appropriation to PSP beginning in FY 2002-2003 from $28 million to
$26.2 million.
3.
Appropriates
$6 million in FY 2001-2002 from the medically needy account to AHCCCS to offset
losses associated with HCG.
4.
Establishes
a new Medicaid category that expands AHCCCS coverage beginning on January 1,
2002 to persons who due to their disability are eligible for SSI or SSDI and
whose incomes do not exceed 250 percent FPL.
5.
Appropriates
$800,000 from the state general fund to AHCCCS to increase reimbursement to
small rural hospitals that are designated as critical access hospitals.
Amendments Adopted by Appropriations Committee
1.
Includes
the provisions of the Health Committee amendment.
2. Requires the AHCCCS Director to prescribe the circumstances to grant a hardship exemption to the disenrollment requirements for a member who is not able to pay the premiums under CHIP.
3. Eliminates the required six-month waiting period for eligibility when a child’s health insurance coverage is voluntarily dropped.
4. Allows the Director of AHCCCS to adopt rules that require a time period during which a child who voluntarily discontinues insurance coverage must remain uninsured.
5.
Eliminates
the allocation of tobacco settlement monies to HCG.
House Action Senate
Action
HEA 2/19/01 DPA 10-0-0-0 HEA 4/3/01 DPA 7-0-1-0
APPROP 2/27/01 DPA 12-3-0-1 APPROP 4/10/01 DPA 12-0-0
3rd Read 3/14/01 47-7-6-0
Prepared by Senate Staff
April 16, 2001