A Response to the Arizona Crisis

I wanted to share this response with you from a comment made to my "This is Awful" post.  I really appreciate the research Julie has done on this topic.  She is a mother of a child with CF, so I truly value her feedback.


It saddens me that the transplant patients in AZ who happen to be so low
income that they qualify for Medicaid will no longer have access to
transplants. Although I want to find out the background of why this
happened because I think it is important to research what caused the
decision in the first place so that perhaps other patients at or below the
poverty level do not have to suffer the same consequences. There has been
much speculation of fault in this instance, but for me it is not so much
about fault, but about what preceded the decision that needs more scrutiny.

After extensive research I found that much of this rationing is directly
related to what is coming with the new federal health care reform law. AZ
was the first to catch public scrutiny but it won’t be the last.

AZ is currently facing the worst debt crisis in that states history. This
decision in AZ was not done lightly, and since states cannot print their own
money, they are going to have to do something to save their state from being
bankrupt and issuing IOU’s like other states already bankrupt. There were
reviews, legislative voting & sessions, meetings, public input,
recommendations from UNOS & transplant surgeons etc. I have summarized much
of it, but all of that documentation can be found here:

spx

AZ tried to eliminate coverage for Gastric Bypass Surgery but Federal
requirements prohibit the elimination of this benefit. (I do find it
strange that the federal requirements prohibit weight loss surgery from
being eliminated but say nothing about transplants.) The benefit fact sheet
from AZ is hereà

hanges_factsheet.pdf

None of the changes affected children’s benefits whatsoever. Also, members
with incomes at or below 100 % of the federal poverty level (FPL) who are
also Medicare eligible will continue to receive Medicare covered services
that are no longer covered by AZ. For members with incomes greater than
100% FPL who are also Medicare eligible will not receive the Medicare
covered services that are no longer covered by AZ.

Lung transplants are still covered for patients in AZ who are 21 and
younger. The details of the new law on transplants in AZ (entire document
here:

ary10_6_10.pdf )

Summary of transplant coverage in AZ follows below:

Heart Transplants- Covered except for non-ischemic cardio myopathies

Heart & Lung Transplants- Covered for members 21 and younger

Lung (single and double) - Covered for members 21 and younger

Liver Transplant- Covered except for members with a diagnosis of Hepatitis C

Kidney (cadaveric and live donor)- Covered

Simultaneous Pancreas/Kidney (SPK)- Covered

Pancreas after Kidney (PAK)- Covered for members under 21

Visceral Transplantation (includes intestine alone, or intestine +pancreas,
+liver)- Covered for members under 21

Pancreas Only- Covered for members under 21

Stem Cell Transplants- Covered in all instances except for Allogeneic
Unrelated for members over 21

Cornea- covered

Bone- covered

I did find out that transplant eligibility remains for patients currently on
the transplant list, so people we are on the transplant list are not left
high and dry. It is the new law and you can find it on page 25 here:


I have friends in AZ and specifically one who recently lost her daughter
from cf who was a tender age of 10. I know AZ is suffering the worst
economic decline in that state’s history and they have been trying since
before 2009 to figure out where they will be able to keep themselves from
going bankrupt. Since the new health reform law is going to force the state
to dramatically expand the number of patients on Medicaid in AZ, they
started looking there first.

Medicaid is a program for very low income individuals with no age
requirement that each state funds a large portion of with some help from the
federal government. The state is allowed to make some rules, but some come
from the federal government cms.gov. AZ found they could save money by
reducing or waiving the requirement to provide non-emergency medical
transportation for certain populations. In other words they wanted to no
longer provide coverage for non-emergency transportation in ambulances.
Since the federal government mandates this particular coverage, AZ wrote to
cms.gov to get their permission. It would have saved AZ $4,722,041 if this
would have been done. The letter to the feds was sent just this past summer
in August 2010 and all the info I just stated can be seen in the actual
letter here à

10.pdf

As of today there has been no response from the Center for Medicare &
Medicaid service.