(C) Arizona Mirror
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‘We’re real people’: Arizona Medicaid recipients brace for devastating cuts [1]
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Date: 2025-07-11
Federal fallout As federal funding and systems dwindle, states are left to decide how and whether to make up the difference.
Read the latest As federal funding and systems dwindle, states are left to decide how and whether to make up the difference.
A mother who works two jobs and her three children, the oldest with severe asthma. A woman with Down syndrome whose mother has worked for decades to ensure her daughter has the best life possible. A family with two parents working full-time and a son with disabilities who requires numerous therapies and round-the-clock care.
These are just a handful of the Arizonans who are at risk of losing all or part of their Medicaid coverage because of the massive cuts in President Donald Trump’s “One Big Beautiful Bill Act.” The cuts to Medicaid, which provides insurance for 80 million Americans with low-incomes or disabilities, will help fund the extension of Trump’s 2017 tax cuts, which primarily benefit the wealthy.
More than two million Arizonans are on Medicaid and receive health care coverage through the Arizona Health Care Cost Containment System, the state’s Medicaid program that is better known as AHCCCS. Thanks to Trump’s budget, which was backed by all of Arizona’s GOP congressmen — Andy Biggs, Juan Ciscomani, Eli Crane, Paul Gosar, Abe Hamadeh and David Schweikert — an estimated 300,000 people will lose their health insurance.
Alicia Jefferson, who works more than 40 hours a week between two bartending and server jobs in the Valley, told the Arizona Mirror that if she loses AHCCCS coverage, she’ll have to travel to Mexico to get her son’s inhalers. If she had to pay for them out of pocket in the U.S., they would cost $1,000 a month.
“I was in tears,” Jefferson said about her reaction to hearing that Congress had voted to pass the bill. “We aren’t just leeches, and we’re not just cogs in a capitalist wheel. We’re real people.”
The budget plan slashes an estimated $1 trillion from federal Medicaid funding across the country over the next 10 years, according to the Congressional Budget Office.
Trump repeatedly promised during the 2024 campaign that he wouldn’t cut Medicaid benefits, and the White House claimed in a statement that the spending and tax bill would “eliminate waste, fraud and abuse.” But there’s no way the Grand Canyon State’s Medicaid program can take the estimated $35 billion loss in federal funding over the next decade without cutting services or kicking people who need it off the rolls.
At this point, it’s hard to say how the cuts will be implemented at the state level and which people and services will be on the chopping block. But it’s clear that AHCCCS cannot continue as is while taking such a huge hit to its funding, about 70% of which comes from the federal government.
The total annual budget for AHCCCS is about $22 billion, and KFF, a nonprofit focused on health policy and analysis, estimates that the Republican budget will slash that by about 19%. With a total annual state budget of $17.6 billion, there’s no way Arizona can make up the difference. KFF estimates that more than 300,000 Arizonans could lose their health insurance as a result.
In a letter to the state’s congressional delegation earlier this month asking them not to vote for the bill, Arizona Gov. Katie Hobbs wrote that the federal spending plan came with “costs to the State of Arizona that our taxpayers cannot absorb.”
But Will Humble, executive Director of the Arizona Public Health Association, told the Arizona Mirror that now isn’t the time to panic.
“Just looking at it as a practical matter, a lot of these cuts aren’t going to happen,” he said.
The provisions in the bill that are set to make some of the most significant cuts to Medicaid — work requirements, more frequent eligibility determinations and limits on providers taxes — won’t be implemented right away. Work requirements and eligibility determinations every six months instead of every year are set to go into effect at the end of 2026, and provider tax caps are set to be implemented incrementally starting in 2028.
Arizona levies a 6% provider tax on hospitals to help pay for the state’s share of Medicaid. The bill will reduce that amount by half a percent annually until it reaches the new 3.5% cap in 2032.
Humble told the Mirror that the delays in implementation of these provisions will give advocates years to convince members of Congress to reverse the cuts.
Humble, a former director of the Arizona Department of Health Services, said that he believes the work requirements are the most likely to be implemented. But he said that rural hospitals, which would be hit the hardest by provider tax cuts, will aggressively lobby their congressmen to reverse the cuts, or beg their state legislators to backfill the difference.
Rural Arizonans are far more likely to rely on Medicaid for health care — about 38%, compared to 17% in urban areas. That means that rural hospitals, which already operate with smaller profit margins, rely more heavily on Medicaid funding.
The provider tax cap would cost Arizona around $75 million to backfill the difference in the first year, and Humble told the Mirror he can’t imagine the state allowing such a devastating impact on rural communities for such a relatively small price.
If Arizona’s legislature refuses to make up the difference, rural hospitals in ruby red areas of the state could close down, and residents are unlikely to be pleased about that.
“Rural legislators in deep, red spots will eventually come to realize that older voters in their district still want a hospital,” Humble said.
Proponents of the cuts have sold the more frequent eligibility checks and work requirements as a way to keep scammers and able-bodied adults who simply don’t want to work from taking advantage of the system. But advocates expect those additional hurdles will cull many people who qualify for the program but are unable to provide the proper proof due to a lack of time, knowledge or technical capabilities.
About 64% of adults on Medicaid already work full- or part-time, and the majority of the people who aren’t working are retired, in school or are full time caregivers for a family member. Nearly half of all those enrolled in Medicaid nationwide are children.
Arizona was already set to implement its own Medicaid work requirements this fall, stemming from legislation signed by Gov. Doug Ducey in 2015. AHCCCS did not respond to questions about whether those requirements would be implemented in October, or if they would wait for the new federal deadline.
Other states that have already implemented work requirements, like Arkansas and Georgia, have spent millions of dollars on systems that are difficult to use and cost more than they’ve saved the state. People with disabilities and those experiencing homelessness are the most at-risk of losing coverage because of inability to keep up with reporting requirements. In Arkansas, tens of thousands of people lost access to health care, resulting in adverse effects for many.
“Adding more requirements that people reapply or be redetermined is going to make it just amazingly more difficult,” Jon Meyers, executive director of the Arizona Developmental Disabilities Planning Council, told the Mirror. “And many people are simply not going to be able to do it.”
Families at risk
Jefferson’s family has relied on Medicaid off-and-on for years, depending on whether her job provided health insurance. Right now, she and her three children, 17-year-old Dominick, 7-year-old Chloe and 6-month-old Damien, all rely on AHCCCS for health care coverage.
“Everyone I’ve ever known who gets Medicaid, they’ve always worked,” Jefferson said. “They’re not just sitting there leeching off of the system.”
Without Medicaid to cover Dominick’s inhalers to treat his severe asthma, Jefferson said she’ll either have to travel to Mexico for medicine, which she did in the past when her private insurance wouldn’t cover it, or rack up medical debt.
“I refuse to let my son die,” she said.
The situation is also causing stress for Dominick, who feels guilty for the cost of treating his asthma, Jefferson said.
“He now feels like he’s a burden,” she said.
When her children are asleep, Jefferson said she cries in the bathroom with worries about the future, but added that she knows she’ll get through whatever happens.
Deb Sinclair, 69, is a retired nurse who returned to Arizona from Maine about four years ago with her 44-year-old daughter, Kelly Forant, who has Down syndrome. They made the cross-country move because of the superior quality of the AHCCCS program.
Forant has been enrolled in Medicaid for most of her life. It pays for her prescription medications that cost around $1,000 a month, part of her dental care and for the day program she attends for 40 hours each week.
If Forant was kicked off AHCCCS, she would be in a more fortunate situation that most like her, Sinclair said. Sinclair has set up a trust in her daughter’s name that could pay for her medications and other care, if necessary.
But that trust is meant to allow Forant to stay in her home and be well cared for after her mother dies, something Sinclair has been working hard to achieve for decades. If too much of that money was used up now to pay for routine care, Forant’s future would look much different.
“I worked a lifetime to make sure she was going to be taken care of, quite frankly, and I’ve paid my dues,” Sinclair said. “I want her to have the best life she possibly can.”
But Sinclair said she still believes that losing access to day programming, provided via a Medicaid waiver, would be even more detrimental. Waiver programs provide ongoing care beyond standard Medicaid requirements, and some advocates are worried they will be the first things cut to make up for the loss in federal funding.
Sinclair saw exactly how that loss of structure and social interaction impacted her daughter when programs were shut down at the start of the COVID-19 pandemic.
“We saw terrible regression in her speech and in her ability to care for herself or do things for herself,” Sinclair said. “Just the isolation was unbelievable. She wouldn’t leave her room. She wouldn’t get dressed. She wouldn’t go anywhere.”
The program that Forant attends includes things like culinary, music classes and karate classes, as well as life and social skills. She also makes friends there, and the time she’s away from home provides Sinclair with a respite from caring for her daughter, a 24/7 job.
Exhausted, but still fighting
Brandi Coon and Kathleen Muldoon were part of a group of mothers who in April won a months-long fight to persuade the Arizona Legislature to provide $122 million in additional funding to ensure their children and others with disabilities didn’t lose access to vital services provided through Medicaid.
Even though they’re still tired from months of trudging to the Capitol to convince lawmakers that funding the state’s Division of Developmental Disabilities was the right thing to do, they’re ready to do it again.
Muldoon’s 11-year-old son, Gideon, has 42 medical diagnoses, including visual impairment, cerebral palsy and deafness. He relies on his parents as well as a team of 20 medical professionals, provided through Medicaid, to navigate everyday life.
While Muldoon has heard the narratives that cuts won’t impact her son because of his high level of need, she’s not buying it. Gideon’s at-home care that helps him build physical strength, to better communicate and be successful at school are all provided through Arizona’s Medicaid waiver program.
Muldoon, who is a medical school professor, said that waiver programs have been the first to go when Medicaid was cut in the past. And those services aren’t covered by private medical insurance.
If they were cut, it would put Muldoon in a difficult spot, possibly forcing her to take on additional jobs and to have little time to spend with her family, including her two other children.
These cuts, she said, send a troubling message to people with disabilities and their families.
“The overall message is that people with disabilities are dispensable, that the needs of my son and our family are optional,” Muldoon said. “Medicaid gives us access to the things that everybody should have access to, such as education and social supports and community involvement.”
Even so, Muldoon said she’s encouraged by the relationships she formed during the fight for DDD funding this spring and is ready to continue educating lawmakers about the value that disabled people contribute to society.
Coon told the Mirror that she will also continue to educate legislators about the importance of DDD services to those who need them, with the hope that they won’t be cut to make up for decreased federal funding.
Coon, co-founder of the Raising Voices Coalition, one of the organizations that led the battle for DDD funding, said she’ll take what she learned through that experience into this next fight.
“I’m honestly in awe of the win that we had,” she said, adding that she believes the key to success was a broad coalition of advocates who worked with lawmakers on both sides of the aisle.
She’s specifically planning to hold Biggs, who voted for the “big, beautiful bill,” to his word that he doesn’t want to see vulnerable populations or people with disabilities harmed by the cuts.
“I’m sure that he understands what strong advocates and grassroom efforts we have in the disabled population in Arizona,” she said.
Biggs is running for governor in 2026.
Meyers, the executive director of the Arizona Developmental Disabilities Planning Council, predicts that tens of thousands of Arizonans with disabilities will be culled from AHCCCS or lose access to services if the cuts are implemented.
“If they lose their prescription coverage, if they lose their health care coverage, if they lose the kind of therapies and supports that allow them to have mobility in their communities and have ongoing engagement with their communities, their health is clearly going to suffer,” he said. “And as a result, some will die.”
He predicts that some of them will end up living on the street.
“Fundamentally, the message that gets sent is that people with disabilities are expendable, that they’re really not useful members of our society, that they really have no value to our communities,” Meyers said. “And as a result, if they lose their services, if they lose their health care, if they ultimately die, we’re no worse off.”
On a personal level, Meyers said he knows most people cherish the people in their lives who have disabilities, but this legislation tells them they are “just takers.”
Impact beyond Medicaid enrollees
Cuts to AHCCCS will make health care in Arizona more expensive and less accessible for everyone, January Contreras, executive director for Children’s Action Alliance, told the Mirror. That’s because people who lose their Medicaid coverage still get sick and need treatment.
“People wouldn’t have any option but to go to the hospital, and when people use hospitals as their primary care, it’s very expensive for hospitals,” Contreras said. “And that has to be passed on to employers and all the folks who get health insurance through their employers.”
This could lead to providers closing their doors in rural parts of the state, where people already struggle to find specialists and might already have to drive more than hour for care.
According to a University of North Carolina study, the federal Medicaid cuts will put five rural Arizona hospitals at risk of closing, in Page, Winslow, Nogales, Bisbee and Globe.
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https://azmirror.com/2025/07/11/were-real-people-arizona-medicaid-recipients-brace-for-devastating-cuts/
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