Associated Press

A proposal that could force able-bodied Medicaid recipients to get jobs and limit some to a maximum of five years of insurance is on its way to Gov. Jan Brewer for consideration after the House gave final approval to Republican House Speaker Andy Tobin's bill on Thursday.

House Bill 2367 requires the state's Medicaid program to apply for a waiver from federal regulators every year to allow it to impose the new rules. Federal officials at the Centers for Medicare and Medicaid Services reiterated Thursday that the work-rule and time-limit proposals likely run counter to Medicaid's laws and regulations. Tobin, however, has said he believes Medicaid's position could change over time.

Tobin's bill also imposes co-pays on unneeded ambulance and emergency-room use. He has said the rules are needed to protect the state from excess expenses. Democrats argue that they would limit the effectiveness of the health system for poor Arizonans.

The bill passed the Senate and the House on party-line votes, with majority Republicans in support and Democrats opposed.

There was little discussion during the final vote on Thursday.

An analysis of the bill's impact released Wednesday by the Legislature's budget experts estimated that 141,000 current Medicaid recipients would lose coverage under Tobin's lifetime limit. That could save the state nearly $150million a year. Only about half of the 440,000 able-bodied adults now getting insurance meet the work requirement. More than 1.4million Arizonans were enrolled in the state's health-insurance plan for the poor as of April1.

As originally introduced in February, the bill would have a hard limit of five years for anyone getting Medicaid.

After an outcry from Democrats over its effect on the working poor, Tobin changed that provision, and it now affects only people who are able-bodied and don't work. The bill does not define "able-bodied." He also added exemptions for pregnant women, those on disability benefits and those caring for young children.

Tobin, R-Paulden, said that the federal opposition could change and that the requirements give the state tools to cut enrollment if the government fails to fund the program as promised.

Tobin's proposal includes a requirement for a co-pay for unneeded visits to hospital emergency rooms or ambulance use. The federal government had allowed Arizona to charge $30 co-pays for unneeded ER visits, but that expired Dec.31. Arizona is now asking federal officials for authority to charge $200 for such visits for newly eligible people on the state's Medicaid plan, the Arizona Health Care Cost Containment System.

Rep. Eric Meyer, D-Paradise Valley, said Tobin is trying to limit the reach of the program.

A Medicaid-expansion proposal pushed by Brewer last year led to a fracture among fellow Republicans and an impasse she broke by calling a special legislative session.