FAA1.A Background and Introduction : 10 Outside Agencies : A Outside Agencies - Arizona Health Care Cost Containment System (AHCCCS)
A Outside Agencies - Arizona Health Care Cost Containment System (AHCCCS)
 
(2/01/14 - 03/31/14)
Arizona Health Care Cost Containment System (AHCCCS) is the state agency identified by the federal government as the administrator of the Medicaid program in Arizona.
 
AHCCCS supervises the planning, implementation and continued operation of Arizona's version of Medicaid. AHCCCS contracts with the Department of Economic Security (DES) Family Assistance Administration (FAA) to determine eligibility for certain Medicaid categories.
 
AHCCCS is funded by both federal and state governments. Title XIX of the Social Security Act of 1965 establishes the laws that govern MA.
 
Policy for the Medical Assistance (MA) Program is found in the Medical Assistance Eligibility Policy Manual (EPM) located at the following website:
 
The EPM includes, but is not limited to, the following MA policies:
 
Transitional Medical Assistance (TMA)
KidsCare
ALTCS
MAGI
Deemed Newborn
 
Traditional Medicaid models pay a fee-for-service, while AHCCCS pays a monthly per person amount to contracted health plans. AHCCCS uses the fee-for-service model in certain circumstances.
 
AHCCCS is also responsible for the following:
 
Developing and maintaining rules for the Medical Assistance (MA) program.
Contracting with health plans and providers to meet medical needs of participants.
Enrolling participants in capitated health plans and providing six-month guaranteed enrollment.
Promoting AHCCCS contracted services.
 
NOTE AHCCCS provides FAA with program information regarding services.
 
Determining eligibility for Long Term Care (LTC).
Determining eligibility for KidsCare.
Determining and maintaining eligibility for Title XIX when AHCCCS completes the eligibility process for a KidsCare case with Title XIX eligible participants.
Determining medical assistance eligibility for Supplemental Security Income (SSI) related participants, including emergency services for nonqualified noncitizens who are aged, blind, or disabled.
 
For further information, see AHCCCS Contact Information.
 
AHCCCS health plans work like private health insurance and promote preventative health care. The participant does not make premium payments to receive services.
 
EXCEPTION
Participants approved for KidsCare or Freedom to Work programs have premium payments.
NOTE AHCCCS determines and notifies the participant of the premium.
 
Participants may be required to pay a co-payment when medical services are received. ALL co-payments are collected by the medical provider when medical services are provided. Non-payment of ANY co-payment DOES NOT affect MA eligibility.
 
EXCEPTION
The following participants DO NOT have co-payments:
Age 19 and over when enrolled with Children's Rehabilitative Services
Approved for Family Planning Extension Services coverage
Approved for KidsCare
Native American
Pregnant
Under age 19
 
AHCCCS health plans include, but are not limited to, the following services for eligible participants:
 
Behavioral health services including substance and drug abuse
Complete physical examinations
Doctor's office visits
Emergency dental care
Emergency medical care (24-hour)
Eye testing and eyeglasses
Hearing tests and hearing aids
Hospital care
Immunizations
Lab work and X-rays
Labor and delivery
Nutritional educational information
Prenatal care
Prescriptions and medical supplies
Speech testing
Transportation for medical emergencies
Transportation for non-emergencies, when medically necessary and no public, private or free transportation is available
Well-baby care, including free check-ups and immunizations