This started out as a comment to Joan McCarter’s story, “With Trumpcare back in the grave, red states move to slash Medicaid on their own.” I decided it was better to expand my comment and make this a story all on it’s own.
I am one of the people who will be financially devastated if Arizona makes it any harder than it already is to get and keep Medicaid. I am disabled and am what they call “dual eligible” for Medicaid and Medicare. You have to be pretty poor to get this, even if you have Social Security income. Medicaid picks up most of whatever Medicare doesn’t pay for. I usually only pay co-payments for my medications, which is less than $20 a month now. I have several medically necessary supplements I take, but are considered OTC and are not paid for. This is where a bigger chunk of my SSDI goes for my medical care. I think it is important to know just what people are already going through here to get and keep Medicaid, and other public assistance, in Arizona and many other red states. Arizona’s system is a nightmare, but we are not the worst. I know many of you are aware that Republicans have made it difficult to almost impossible to apply for and continue to receive Medicaid and other public assistance. It is a different thing to know exactly how this is being done.
Applying in the Digital Age
In order to maintain my Medicaid and SNAP benefits, I have to go through a week of extreme stress and frustration twice a year. In Arizona, they have gone almost entirely to an online system for applying for and renewing Medicaid, TANF, and SNAP benefits. They closed many Department of Economic Security (DES) offices across the state a few years ago. This was done ostensibly to save money and make the system more efficient. The new system has lots of traps built into it to intentionally make it very difficult to apply for benefits. Closing DES offices has been problematic, because a large number of people here live in rural areas. If you live a long way from a DES office, don’t have access to the internet somehow, and no friend or family member to help; no benefits for you. If you do have access to the internet, you had better be pretty computer literate to get through the application process. If you are lucky enough to have a DES office close enough to get to, get ready to wait, and wait, to talk to anybody. You’ll be there for a few hours. In the few local offices left, they have a skeleton staff of less than 20 people to handle Medicaid, TANF, SNAP, Childcare Assistance, required work programs, Arizona Long Term Care System (ALTCS), and probably several other programs. If you have a job, you will either need to have at least a day off during the work week, or have a friend or family member available who can apply on your behalf if you can’t get time off.
I could go on about this horrible system all day. I have a million stories I could tell, but I’ll try to keep it as short as I can. The online application system, in Arizona, is NOT user friendly, and it will take the better part of two hours, or more, and a lot of trial and error to get through the process and correctly complete the application. I won’t get into the gory details, let’s just say you will be ready to inflict serious damage to your computer, yourself, or others, before you are done. Even if you are doing a renewal, and have all the tons of documentation they want uploaded to their system, something will have changed and it will not be everything they want. You will be surprised with this when you complete an interview with a person.
The Interview
You must complete an interview before your application will be considered for approval. They give the number for the interview line and instructions on the final page once your application is submitted, and/or they send you a letter in the mail. At this stage, you call their interview line, and wait on hold. This wait time is capped at two hours by their phone system. If you call on the first or last week of the month, you will very likely either not be able to get through at all, or you will wait on hold for the whole two hours, be disconnected from your call by the computer and will have to start over. Again, this is a hardship for many poor people because they may not have a phone, or pre-paid minutes will be used up, or, or, or. You get the idea. If you can get through to talk to someone, you will spend about an hour on the call explaining many times that yes, you have uploaded the documentation, it is there. (Did I mention you will need access to a scanner also?)
If you are lucky, the interviewer has been properly trained, and knows what they are doing. If you have done this many times, you may have to coach an inexperienced interviewer along. They won’t tell you much about the rules, they don’t want you to try to cheat. They are available online from the state of Arizona website, but good luck reading and understanding them. You will figure some of them out if you have to reapply a few times. Sometimes, they slip and tell you things they don’t really want you to know. I once found out that I had been “awarded” far less in SNAP benefits (over $100 a month) for 6 months because my previous interviewer had counted my son’s college work-study pay as income. It is not supposed to be counted as income because it is a grant program to help pay for college. I had asked at the time why our SNAP benefit decreased so much, but did not get a sufficient answer. They don’t give you that money retroactively. You are told, “Sorry about that, our bad.” You should have your documentation in front of you during the interview, and try to make sure you ask all your questions in the interview, you may not get another chance.
It’s Even Harder if You Work
If you are not already employed, Arizona has a requirement that “able bodied” adults must work a minimum of 20 hours per week to maintain their benefits. This requirement can be met by employment, training programs, school enrollment, searching for work, or any combination of those things. The Obama administration reportedly denied the work requirement in a “waiver” request by Arizona last year, but this has been a requirement here for many years as far as I know. If you work, and have a varying schedule or seasonal fluctuations in pay, which many people on assistance do, you will have to explain to DES why you don’t have a relatively consistent dollar amount from paycheck to paycheck. In addition to pay stubs for a month prior to your application, you will have to get a letter from your employer explaining why you have an inconsistent pay check. This is a requirement, you cannot avoid it. They don’t care if it embarrasses you. If you work under 20 hours a week for the month leading up to your application, you are no longer eligible for Medicaid or SNAP. Period. End of story. You can try again in another month if your hours increase. If you work more than 20 hours in a week, and you get SNAP benefits, your benefits will decrease, sometimes dramatically. Medicaid in Arizona is a little different now since outgoing former governor Jan Brewer opted into the Medicaid expansion. Previously, if your hourly wage went up just enough, they booted you off that too. With Medicaid expansion, unless you have a really dramatic increase in pay, you will probably still be eligible. This is the only thing I can thank Jan Brewer for.
Don’t Call Us, We’ll Contact You
If you have questions after your interview has been completed, you have a whole new problem. The automated phone system knows if you have completed an interview and will block you from getting through to them. You can call their “all purpose customer service line”, but those people really just help with very minor issues and can’t answer questions about benefits or your particular case. Sometimes they will transfer you to an interviewer, but many times they will tell you to call your local office (see where this is going?) because your case has been transferred there. You can also chat with someone through the application website, but again, those are just customer service people who can only help with minor things. You can also send a message through the communication tab in your case page, but I have never received a response through that method when I have used it in the past. They do not tell you in the interview if you are approved for benefits or not. Your case has to be reviewed by a supervisor before a decision is made. Sometimes your application is pulled at random for an audit to make sure everything is correct which adds a few more days to the process.
It usually takes about 2 weeks to get a letter in the mail giving you a decision. You can also use an automated phone service to check periodically to see if you have been approved. In order to do this, you have to create a pin in that system and have your case number available. Don’t forget your pin, or you have a whole new set of problems.
Feel Like a Criminal Yet? Let’s Reinforce That….
At some point in the process, you will be told you have to go to your “local” DES office to have your picture taken and give a fingerprint for ID in their computer system. It makes you feel like you are being booked by the police. Again, this is another problem for rural residents. They will withhold your benefits at some point if you do not do this. I believe this is only required for the person submitting the application and family members over the age of 18 who will be receiving benefits.
Always, Always, Submit Your Renewal On Time
Do not ever, at any point, fail to submit your renewal within the timeline they give you, and make sure they have your current address. They usually notify you about a month in advance of the expiration of your benefits. If you do not submit your renewal before that date, they will close your case, and you will have to start a whole new application process. You will have no Medicaid coverage or other benefits you are eligible for until the process is complete. Your doctor’s office will know this and will ask you to pay the going rate for your visit if your coverage lapses. They check with a Medicaid coverage database to see if you are still covered every time you go to the doctor. You will also have to pay full price for any prescriptions you have filled until your coverage is back in force, which can be a considerable amount. As an example of what could happen, prior to Medicaid expansion, Arizona capped the number of single people who could be receiving Medicaid and other benefits. They “grandfathered” the people already in the system, but would not take any new applications. They further reduced Arizona’s single person Medicaid roll through attrition. This was accomplished by a rule change stating that any single person who did not renew their application on time had their case closed, and could not reapply.
The Changes to Come
I previously mentioned Arizona has a 20 hour a week work requirement if you are an “able bodied” adult, 18 or older, and are not the sole caregiver for children under age 6. You are also exempt if you are temporarily or permanently disabled, or attend high school. Arizona has again asked for a waiver to allow a 5 year lifetime cap on Medicaid benefits for people who fall under work requirements. The Obama administration denied it last year, but Trump’s will probably be all for it.
Arizona also has an approved waiver on hold pending the outcome of the healthcare debacle in Congress. This will require that Medicaid recipients pay $25, or 2% of their total household income, whichever is larger, to the State of Arizona. That payment will be deposited into a healthcare savings account to be used for non-covered services like dental and vision. If you fail to pay this fee for 2 months, you will be temporarily removed from the Medicaid roll. “Temporarily” has not been defined yet as far as I am aware. Arizona originally asked for a 6 month ban for non payment, which was denied. Of course, these healthcare savings accounts will be overseen by a private sector company yet to be announced.
Other proposals that were denied were charging Medicaid recipients a fee for missed appointments, and requiring that people earning below the federal poverty level also contribute to a healthcare savings account. The Obama administration stated that those earning below federal poverty level can choose to participate in that program, but the state could not require it.
Additionally, a change may occur to a policy regarding failure to report a change in income, family size, or employment status. Currently, failure to report changes may get you a reprimand, and paying back any benefits you received that you were not eligible for, usually SNAP or TANF payments. However, I believe you can be kicked out of these programs and Medicaid if the unreported change is significant, or you are a repeat offender. The prospect of reimbursing the State is painful enough that most people report income changes when they should. The most recent Arizona waiver request would revise the unreported income change penalty to being banned from Medicaid for one year.
Arizona Isn’t The Worst, And Who Is Driving This Train?
I am only describing what is happening in Arizona. There are all kinds of insidious rules and restrictions being passed all over the country. Starting in 2010, Kaiser Family Foundation reports a dramatic increase in the number of states reporting at least one Medicaid benefit restriction. The upper income limits for Medicaid eligibility in Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, North Carolina, Oklahoma, Utah, and Virginia are all under $9000 for a family of three. Alabama and Texas are tied for the lowest; you have to make $3675 or less, per year, to qualify for Medicaid for a family of three (see table 4 at this link). In the table I cite, you’ll see that several states have exactly the same dollar amount for their upper income limit. In May of this year, in an effort to thwart Governor John Kasich’s acceptance of Medicaid expansion, Ohio House Republicans tried to introduce an amendment to freeze enrollment to new or returning applicants. That didn’t fly, but they did add an amendment to their budget bill to request a waiver from the federal government to charge enrollees for premiums and “other fees.” Sound familiar?
The similarities of these restrictions are not a coincidence. Many of the restrictions and rule changes designed to make it harder to obtain and keep Medicaid coverage have been brought to you by ALEC, The Heritage Foundation, and other conservative interest groups. These groups write legislation and make it available to state lawmakers, who can then tailor various bills as they see fit. I found this great article with a link to a data mining tool that exposes the lobbying groups who are writing all this “model legislation”. They have figured out that passing bills which gradually erode Medicaid coverage works better than a full on attack. Kind of like Grover Norquist’s idea of making government small enough to drown it in a bathtub. This helps them avoid large groups of people with pitchforks and torches. As it turns out, killing Medicaid is not a popular idea in America, but usually not unpopular enough to drive large numbers of people into the streets in protest.
What We Can Do About It
What we can do to protect Medicaid is pay attention to the bills our state legislatures are attempting to pass regarding Medicaid benefits management and funding in addition to U.S. Congressional legislation. Setting up an alert in your preferred news feed can make it easier to do this. I signed up for and receive e-mail newsletters from advocacy groups and the Arizona Democratic Party who let me know when there are bills coming up for votes in the Arizona legislature. I also try to keep up with posts on Daily Kos about Medicaid news, also an excellent source. If you know there is a vote coming up in your state attempting to restrict Medicaid, contact your state representatives, and share it with us here on DKos. Participate in a protest if you can.
I cannot stress this enough, your advocacy as an individual is important!
We saw that with the Senate Republican’s Trumpcare vote almost two weeks ago. We flooded their offices with letters, faxes, and phone calls. Our voices were heard, but they are not going to just drop it, regardless of what they say. Republicans will try many things in order to achieve their goal of decimating Medicaid, and other safety net programs. We have to keep our eye on the ball, and fight this on the state and national level. Chances are, you, or someone you know, will need Medicaid coverage during your lifetime. Let’s work together to make sure it is there, it is accessible, and it will cover your medical expenses when you need it.
Sunday, Aug 6, 2017 · 11:44:16 PM +00:00 · coocooforcocoapuffs
After I posted this, I read this article about new laws taking effect in Arizona on Wednesday of this week. One of the changes our legislators made was regarding the “booking” photo and fingerprint I mentioned above. They are no longer going to require it because, surprise, it was costing the state more to implement the original policy than it would have saved by catching fraudulent applications.
Monday, Aug 7, 2017 · 5:47:29 AM +00:00
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coocooforcocoapuffs
Wow! I am really honored to have a story in the Community Spotlight. Thanks to everyone who has commented and shared this. I really appreciate it. I also want people to feel free to share their experiences. We’re all in this together and need to know what we are fighting.