Last month, a judge determined that AHCCCS — Arizona’s version of Medicaid — had improperly issued contracts to health care companies that provide long-term care services to 26,000 older adults and people with physical disabilities. AHCCCS has until early next week to decide what it will do, leaving some families worried and uncertain.
Sara Scoville-Weaver is sitting on her 78-year-old mother Sheila Scoville’s twin bed at her group home in Scottsdale. Sheila has late-stage Alzheimer’s disease. She moved her mother here last fall.
“It’s just such a beautiful home,” says Sara. “They are fully trained in dementia, which is the only one that I found where the staff actually have certified training.”
And this home takes ALTCS, Arizona’s Long-Term Care System, which helps pay for her mother’s care.
But in December, AHCCCS, which oversees ALTCS, announced that many members would be switching to new health plans. It had awarded contracts to Arizona Complete Health and United Healthcare.
The health plan that pays Sheila’s $4,800 monthly room and board did not get a contract.
“Finding a home that is clean, and where I don't need to come every day to check on her and make sure she's OK — that's everything to us,” says Sara.
Running in circles
In Arizona, the median cost of long-term care can run anywhere between $5,500 and $9,400 a month.
And most Arizonans, like Sara and her mother, can't afford that without ALTCS. So, fearful of not being able to keep her mother in the home she loves, Sara calls AHCCCS hoping for a solution.
“And they said, ‘We have no idea what you're talking about.’ I called again every month after. I left voicemails for several supervisors … never heard back," she said.
Then, in June, Sara gets an undated letter from AHCCCS about the two new providers.
"Finding a home that is clean, and where I don't need to come every day to check on her and make sure she's OK — that's everything to us."Sara Scoville-Weaver
“And this is the only communication I've ever received from AHCCCS talking to me about the Notice of Change," she said.
The letter also states that her mother had been enrolled in Arizona Complete Health: "And this enrollment assignment was made in order to ensure a smooth transition for both you and your caregivers.”
“I called the owner of my mom's group home right away, and I said, ‘Do you have either of these plans?’ And he said, ‘No.’”
Nowhere to go but up
Sara panics.
“And so I immediately called AHCCCS and I said, ‘I don't know what to do. I got this letter.’ And they said, ‘Yeah, you need to choose," she says, between the plan her mother was assigned and United Health. And she had to choose by July 31, even though the owner of the group home hadn’t contracted with either carrier.
“And I said, ‘What if I stick with Arizona Complete, but he gets United?’ And they said, ‘Then you have to move her. You'll have 90 days of coverage, and then you have to move her.’ And I said, ‘Well, that's unacceptable to me.’”
Sara is running out of time. The group home owner has applied to Arizona Complete Health and it’s a waiting game.
Meanwhile, Sara is pushing. She Googles the phone number for AHCCCS CEO, Carmen Heredia, and leaves a message.
"It felt like at the SMAC meeting, I was the first member that they'd ever heard from at all."Sara Scoville-Weaver
“I got a call back the same day from a representative for AHCCCS, not Ms. Heredia, and she told me basically the same thing.”
Then, Sara finds out about the upcoming State Medicaid Advisory Committee Meeting known as SMAC, in which several AHCCCS leaders are set to attend virtually, including Carmen Heredia.
“And then at the very end was a public comment, which I spoke up: I'm my mother's only guardian. I'm her, entirely responsible for her. I did not wish to be, but I am. And this is a very, very serious decision for me to make,'" she said.
More confusion
At the meeting, AHCCCS deputy assistant director Christina Quast explains that the July 31 deadline was so the agency could prepare for the Oct. 1 transition to the new health plans.
And that they are aware of those providers that have yet to be contracted, “And encouraging, pushing, highly encouraging, strongly encouraging, to the extent we can with the managed care organization that they contract with those providers," explained Quast at the July 10 SMAC meeting. "And I want to be clear that even if a contract doesn't come to pass, does not necessarily mean you have to move your mother. There's various things that could occur.”
Like a special case agreement, where the health plan would come into an agreement for a specific member’s care.
But for Sara, who has repeatedly been told that if she chooses the wrong health plan, she will have no choice but to move her mother — it goes back to being forced to make an impossible decision without all of the information.
Even Heredia tells Sara that it's the agency’s obligation to make sure people don’t fall through the cracks.
“And it sounds like you're very frustrated and that you are stuck in a predicament," says Heredia on the SMAC call. "And I think there's a lot for us to learn from this experience.”
"It felt like at the SMAC meeting, I was the first member that they'd ever heard from at all," explains Sara. "Like they were, it seemed, shocked to hear from me, in a way."
In a statement to KJZZ News, an AHCCCS spokesperson said that the agency has learned from the initial implementation period the effectiveness of different communication methods.
After all of that, it’s still another waiting game. Days after the judge determined there were flaws in the procurement process, AHCCCS announced that it was pausing the Oct. 1 transition and members would remain with their current health plan.
The AHCCCS Entire Statement to KJZZ News:
AHCCCS has learned from the initial implementation period the effectiveness of different communication methods. AHCCCS will be ensuring emails are sent out to members and providers providing updates on future transition activities. Additionally, we plan on using more frequent web posts and continue to provide public forum opportunities to allow the community to directly express concerns to AHCCCS staff and allow us to make any needed changes. Finally, AHCCCS is also evaluating the public comments, call center data, and call patterns to make any changes to further streamline and improve the member experience.
If ALTCS-EPD members need to update their email address or mailing address, they can call: 1-888-621-6880.
