Medicaid, SCHIP, and Federal Authority²

HIFA Waiver - In 2001, Arizona obtained a waiver to use Title XXI funds to expand coverage to two populations: (1) adults over age 18 without dependent children and with adjusted net family income below 100 percent FPL; and (2) individuals with adjusted net family income above 100 percent FPL and at or below 200 percent FPL who are parents of children enrolled in the Arizona Medicaid or SCHIP programs, but who themselves are not eligible for either program.

Reinsurance

Starting in 1986, the Arizona Health Care Cost Containment System (AHCCCS) has operated a healthcare coverage program, Healthcare Group of Arizona (HCG). In 2000, the legislature subsidized the program with $8 million of general funds. In 2004, the subsidy was cut in half to $4 million, and HCG was directed to become financially self-sufficient (funded by premium only) as of July 1, 2005.

Since July of 2005, the state does not subsidize premiums. Employers and employees pay the entire cost of the product. HCG protects carriers using aggregate stop-loss reinsurance financed from member premiums. As of December 2006, HCG reported enrollment of over 24,000 lives (over 8,500 small business groups). More than 90 percent of businesses enrolled have three employees or less.

HCG operates a reinsured product for small business, the self-employed, and political subdivisions. No income limits apply, but HCG does have employee participation requirements and firms must not have offered group insurance for six months. These guaranteed-issue products are delivered by managed care organizations and employees can select between several benefit plan options. In 2006, HCG expanded benefit package choices, creating a statewide Preferred Point of Service product and adding dental and vision benefits.

Other

Primary Care Program - The Arizona Department of Health Services operates a Primary Care Program (PCP) that provides access to primary care health services for uninsured, low-income Arizona residents of all ages. The program serves Arizona residents with family income no greater than 200 percent FPL, who are uninsured and ineligible for AHCCCS, KidsCare, and/or Medicare. The purpose of the program is to develop and maintain an enhanced statewide capacity for delivery of comprehensive, community-based primary (health) care services to low-income, uninsured persons and other medically underserved Arizona residents. The program provides funding for qualified contractors to provide primary and preventive care services, preventive dental services, and limited behavioral health care. Contractors may charge persons a sliding scale fee service for recipients who earn between 100 and 200 percent FPL. Contractors may charge persons a sliding fee scale fee between 100 and 200% FPL.

Notes and Sources

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