Arizona Medicaid Cuts Get Green Light, for Now

Arizona's plan to cut at least 250,000 people from its Medicaid rolls has gained momentum since Kathleen Sebelius, the U.S. health and human services secretary, told Governor Jan Brewer this week that the federal government will not stand in the state's way.

The decision by Sebelius came as a surprise to many observers because the new federal health care law specifically bans states from reducing Medicaid enrollment. Sebelius, however, found an exemption that allows Arizona — and probably other states — to discontinue coverage for two groups of people: non-disabled and non-pregnant adults, as a spokeswoman for the federal Center for Medicare and Medicaid Services tells Kaiser Health News .

What the decision means is that the details of the Arizona cutbacks now will be decided in Phoenix, not in Washington, D.C., as had been widely anticipated.

The federal government's ruling, however, does not mean that the case is closed. It was Arizona voters — not the legislature — who set the state's Medicaid enrollment rules in a 2000 ballot initiative, and the Arizona Constitution prevents lawmakers from changing or repealing voter-approved laws, as Capitol Media Services explains . That means any plan to dramatically cut enrollment is likely to wind up before the state Supreme Court.

Brewer, for her part, acknowledges that "there's probably going to be some lawsuits." But she feels "comfortable" that the law is on her administration's side, arguing that the state cannot provide free health care to hundreds of thousands of people if it does not have the money to do so. 

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