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PHOENIX -- A proposal that could force able-bodied Medicaid recipients to get a job and limit some to a maximum of 5 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 may not be approved because they likely run counter to Medicaid's laws and regulations. Tobin, however, has said he believes Medicaid's position could change.

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

The bill passed both 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 Thursday.

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 only affects people who are able-bodied and don't work. He also added exemptions for pregnant women, those on disability and those caring for young children.

Budget analysts estimate that more than 140,000 current Medicaid recipients would lose coverage.

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

``Clearly, these dollars are going to end up on the backs of the states,'' he said last month. ``All we're doing is saying let's request every year the opportunity for some of these waivers.''

Tobin's proposal also includes a requirement for a copay for unnecessary visits to hospital emergency rooms or ambulance use. The federal government had been allowing Arizona to charge $30 copays for unnecessary emergency room 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, called the Arizona Health Care Cost Containment System, or AHCCCS.

Rep. Eric Meyer, D-Paradise Valley, said Tobin was trying to limit the reach of the program and eventually remove them from eligibility. A Medicaid-expansion proposal pushed by Gov. Jan Brewer last year led to a fracture among fellow Republicans and an impasse she finally broke by calling a special legislative session.

An analysis of the bill's impact released Wednesday by the Legislature's budget analysts estimated that 141,000 current Medicaid recipients would lose coverage under Tobin's lifetime limit. That could save the state nearly $150 million a year. Only about half of the 440,000 able-bodied adults now getting insurance meet the work requirement. A total of more than 1.4 million Arizonans were enrolled in the state's health insurance plan for the poor as of April 1.

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Follow Bob Christie at http://twitter.com/APChristie

Associated Press,

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