Governor gambles on cuts to AHCCCS, and is told by the feds that she won the bet...

...but the voters are standing in the way of her collecting on the bet...

On Tuesday, U.S. Health and Human Services Secretary Kathleen Sebelius sent a response to Governor Jan Brewer's request for a waiver of federal "maintenance of effort" (MOE) standards for Arizona's Medicaid program, called AHCCCS.

From the Arizona Republic, written by Mary K. Reinhart -

Arizona doesn't need federal approval to eliminate 250,000 people from its Medicaid rolls in order to continue to receive federal matching dollars, health officials said Tuesday.

Lawmakers had sought to eliminate coverage for low-income Arizonans to help close a huge budget shortfall, but recently passed federal health reform mandates that states maintain their level of coverage.

In a letter to Brewer today, U.S. Health and Human Services Secretary Kathleen Sebelius said the state's entire program comes up for federal reauthorization Sept. 30, and Arizona could simply choose to stop covering the childless adults who Gov. Jan Brewer and legislative Republicans are seeking to drop from the rolls.

In other words, the feds didn't grant a waiver so much as tell Brewer if she waited until the end of the federal fiscal year, she could just make changes without the need for federal action.  Brewer's almost-gleeful press release on the announcement is here.

Now Brewer faces two related problems with her effort to kick poor people off of AHCCCS -

1.  The affected population (people with an income of up to 100% of the federal poverty level (FPL) isn't covered by a federal dictate or because of a decision by Arizona politicians, but because the voters *overwhelmingly* approved Proposition 204 in November 2000.  The income eligibility standard is voter-protected and cannot be overridden by Brewer or the legislature.  Historically, voters in Arizona have been loathe to overturn measures that were previously approved by the voters themselves, especially when a proposal to do so is pushed by the legislature.

2. If she convinces the legislature to refer this to the ballot, she (and they) will have to deal with the PR nightmare of explaining how the state cannot afford to help Arizona's poorest residents at the same time they're railroading through a bill to give tax gifts to corporations and the wealthy that will eventually cost Arizona taxpayers more than $500 million per year. 

Jan and her clan are going to have to some serious tapdancing on this one if they hope to cash in on the bet that they've made against the lives of Arizona's most vulnerable.