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Looming Medicaid changes put Arizonans at risk of losing coverage

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Stephanie Innes | Arizona Republic

Dr. Derksen shares insights on Medicaid changes

Checking the vitals of a baby

Arizona’s Medicaid agency has a new website aimed at helping people to keep their health insurance coverage when major federal changes to the program, including work requirements, start Jan. 1.

Upcoming modifications to Medicaid across the United States are a result of HR 1, the budget reconciliation bill also known as the One Big Beautiful Bill Act that was signed into law by President Donald Trump on July 4, 2025.

The law mandates, among other changes, imposing work requirements on certain populations enrolled in Medicaid, which is a government health insurance program primarily for people who have low incomes or have disabilities, or both.

Arizona’s $23 billion Medicaid program, which gets about two-thirds of its funding from the federal government, is called the Arizona Health Care Cost Containment System or AHCCCS, pronounced “access.”

The agency’s new website, which launched Sept. 1 in anticipation of the changes, is called https://keepmyahcccs.com/.

The website is one of several outreach and awareness efforts that state Medicaid officials expected to make in anticipation of the biggest operational change in the history of the Arizona program. AHCCCS is sending out more than 400,000 letters to affected enrollees.

Medicaid has been in place since 1965, and each state manages its own Medicaid program. Arizona’s program began in 1982.

Some health policy experts are predicting the changes will result in coverage losses because of an added administrative burden that will end up in people getting kicked off Medicaid solely due to red tape, not because they aren’t eligible for coverage.

A spike in the population of uninsured people would result in crowded emergency rooms of sicker people who have avoided getting preventive care, and increased medical debt incurred by hospitals providing care to uninsured people who can't pay their bills, some experts say.

“If they can’t afford coverage, they go without primary preventive care and end up in the ER. ... Things that could have been prevented aren’t,” said Dr. Daniel Derksen, a public health professor and director of the University of Arizona’s Center for Rural Health.

“It affects not only people who lose coverage, but other people, when they need hospitalization, the system is kind of choked. You don’t really save money by throwing people off of coverage.”

About 418,000 Arizonans are in the affected population

The biggest changes to Medicaid under the new law are work requirements and also twice annual coverage renewals, up from once yearly, in what's known as the “adult expansion” population of Medicaid.

In Arizona, that population as of Aug. 1 included 418,000 people. The program as of Aug. 1 enrolled a total of 1.8 million Arizonans, or nearly one in four state residents.

The new AHCCCS website includes a series of screening questions to help AHCCCS enrollees figure out whether they will be affected by the changes. It also has advice for enrollees to prevent them from getting dropped from the program, including updating their contact information with the agency’s Health-e Arizona Plus portal.

State officials are sending out letters to all 418,000 people in waves during September, AHCCCS spokesperson Johnny Cordoba wrote in an email.

The letter, which is inside a yellow envelope, is for awareness only and does not require any action. If members need to take any action before their renewal, AHCCCS will contact them directly with personalized instructions about what to do and when to do it. 

Besides the website, AHCCCS is working with health plans, providers, community organizations, advocacy groups, and social media, and focus groups of AHCCCS members in developing an ongoing awareness campaign, “so the messaging rollout to members and Arizonans will truly be a community campaign” both now and into next year, Cordoba wrote.

Requirements: 80 hours of work, school or volunteering per month

Some but not all of the 418,000 people in the affected population will need to prove they are working, attending school, participating in a job training program or volunteering in order to comply with the federal requirements.

State officials are able to verify through pay stubs that some people are already meeting the work requirements, but not for everyone.

Several categories of Arizona’s Medicaid expansion populations are exempt from the work requirements, such as pregnant and postpartum women, people who are disabled or medically frail, parents and caretakers of children under 14, caregivers of someone with a disability, American Indians and Alaska Natives. Those already meeting similar requirements under SNAP,  the Supplemental Nutrition Assistance Program once known as food stamps, also are exempt.

Some of the language in an interim final rule for the work requirements remains unclear.

Arizona on June 30 joined a coalition of other states in suing the Trump administration, arguing that provisions of the rule about the work requirements that federal officials published June 3 is too restrictive on the vulnerable people who need the health coverage that Medicaid provides.

People experiencing homelessness are not automatically exempt

The lack of a specific exemption to the work requirements and twice annual renewals for people experiencing homelessness is a worry for social service agencies across the country. Additional documentation is difficult for anyone, but it’s particularly problematic for people who lack a fixed address, said Laura Brennan, senior policy manager for the National Health Care for the Homeless Council.

“It’s a huge concern. This will have an enormous impact on our unhoused population, and on providers as well,” Brennan said.

The national council in July wrote a letter to state Medicaid directors urging policy actions to prevent large numbers of homeless people from losing their health coverage, including releasing a list of conditions, diagnoses, and disorders that will qualify as “medically frail” and developing a simple form that providers and individuals can use to request adding conditions to the list.

In Arizona, providers who work with homeless populations are working, “within the rules passed down to us,” to ensure people don’t lose coverage, said Dr. Jack Palmer, who is the medical director of the street medicine team for Circle the City, a nonprofit with a mission of providing high-quality medical care to people experiencing homelessness and stop them from early, preventable deaths. The organization typically sees about 9,000 patients per year, with 7,000 of them covered by AHCCCS.

“We are working to significantly expand the number of people in our organization with training to do Medicaid enrollment, which is specialized training,” said Palmer, who is also part of a local task force working to mitigate HR 1's effects. “The impact on our population is going to be tremendous.”

All of his patients who are able to work do want jobs, Palmer said. Because preventive care to stay healthy is the baseline necessary to working, getting a job will be that much more difficult if people lose their coverage, he said.

About 760,000 Arizonans lack health insurance now; numbers could rise

Derksen, the UA public health professor, estimates 10% of Arizonans lack health insurance, which works out to about 760,000 people.

Since the end of the COVID-19 public health emergency in March 2023, enrollment in AHCCCS dropped from a high of 2.5 million to the 1.8 million. A freeze on disenrollment during the pandemic caused enrollment to swell, and when the freeze ended, enrollment dropped by about 18,000 people per month, and some of them lost coverage for administrative reasons, Derksen said.

Some of those people may have moved to employer-sponsored coverage, but he suspects others are going without any health insurance, and HR1 could further exacerbate the numbers, he said.

In addition to work requirements and increased renewals, up to 34,000 immigrants who live in Arizona and are lawful U.S. residents could lose their AHCCCS coverage before 2027 because of the law, Cordoba wrote.

Cubans, Haitians and Compact of Free Association immigrants remain fully funded for AHCCCS, but asylees, refugees, humanitarian parolees, victims of human trafficking, and certain abused spouses and children will no longer qualify as of Oct. 1, under the law's provisions.

While some of those lawful immigrants may be able to qualify for federal emergency services, “full Medicaid coverage will no longer be available as a result of federal cuts,” Cordoba wrote.

Arizona has resources for AHCCCS enrollees with questions. In addition to the new https://keepmyahcccs.com/ website, the state offers the following resources for AHCCCS enrollees concerned about the new law:

this article was originally published by The Arizona Republic