Jane Dotson
Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services. AHCCCS covers doctor visits, vaccines, prescriptions, emergency care, hospitalizations, and more. There are two types of health plan change requests. Members can request a Health Plan change by contacting AHCCCS. Members can also choose a health plan that serves the area where they live.
| Characteristics | Values |
|---|---|
| Type of Program | Arizona's Medicaid program |
| Who is it for? | Individuals with limited income and resources |
| Coverage | Doctor visits, vaccines, prescriptions, emergency care, hospitalizations, acute and long-term care, behavioral health, children's care, etc. |
| Eligibility | U.S. citizens or those meeting specific non-citizen requirements; different rules for those eligible for Medicare |
| Cost | No monthly premium; lower copayments compared to employer-sponsored plans |
| Application Support | Community Assistors help with the application process and provide access to necessary equipment |
| Member-directed Options | Self-Directed Attendant Care (SDAC), Agency with Choice |
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What You'll Learn
AHCCCS eligibility
Eligibility for AHCCCS Medical Assistance is determined on a month-by-month basis. A customer may be eligible one month and ineligible the next. Eligibility begins on the first day of the month in most cases.
For those moving to Arizona from out-of-state, eligibility cannot start any earlier than the date of the move. For those who have been in jail or another detention facility, eligibility cannot start any earlier than the date the person is no longer considered an inmate. For newborns, eligibility cannot start any earlier than the date of birth.
Income is usually included when determining eligibility. However, income earned for providing attendant care or personal care services to an ALTCS member living in the same home is considered a Difficulty of Care payment and is not counted against eligibility for some AHCCCS programs.
If you are waiting for your application to be processed or you are not eligible for AHCCCS medical assistance, you may qualify to receive drug, alcohol, and mental health treatment services through other funding sources administered by the Regional Behavioral Health Authority (RBHA).
Community Assistors are available to help applicants understand eligibility rules, submit verification documents (e.g. pay stubs, proof of citizenship), and guide them through the entire process.
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AHCCCS coverage
The Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services. AHCCCS covers doctor visits, vaccines, prescriptions, emergency care, hospitalizations, and more.
AHCCCS contracts with several program contractors to provide long-term care services. An ALTCS program contractor works like a Health Maintenance Organization (HMO). The program contractor works with doctors, nursing homes, assisted living facilities, hospitals, pharmacies, specialists, etc. to provide care. You will also be assigned a case manager who will coordinate your care. In addition to the services listed above, people who qualify for long-term care can receive services such as attendant care, personal care, and homemaker services.
AHCCCS offers member-directed options like Self-Directed Attendant Care (SDAC) and Agency with Choice. Under the SDAC option, the member or their legal guardian serves as the legal employer of the paid caregiver and assumes all employer-based responsibilities. The member or their legal guardian is supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding, and paychecks for the caregiver. Under the Agency with Choice option, the provider agency and the member enter into a relationship and share employer-based responsibilities for the paid caregiver. The provider agency maintains the authority to hire and fire the caregiver and provide or arrange for the required minimum standardized training. The member, or their individual representative, may choose to assume one or more employer-based responsibilities, such as recruiting and selecting caregivers.
Some medical assistance programs may require the participant to make a co-payment when receiving medical services. Some co-payments are mandatory; the medical provider may not provide service if the mandatory co-payment is not paid. However, if you do not have mandatory co-payments, the provider may ask for the co-payment but cannot deny service when you are unable to pay. The KidsCare program requires payment of monthly premiums. If you need to pay a premium, AHCCCS will send a letter to you before your first premium is due.
If you are waiting for your application to be processed or you are not eligible for AHCCCS medical assistance, you may qualify to receive drug and alcohol and mental health treatment services through other funding sources administered by the Regional Behavioral Health Authority (RBHA).
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AHCCCS member-directed options
The Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to Arizona residents. Individuals must meet certain income and other requirements to obtain services. AHCCCS covers doctor visits, vaccines, prescriptions, emergency care, hospitalizations, and more.
One member-directed option is Agency with Choice, which is available to ALTCS members living in their own homes. Under this option, the provider agency and the member enter into a relationship and share employer-based responsibilities for the paid caregiver. The provider agency maintains the authority to hire and fire the caregiver and provide or arrange for the required minimum standardized training for the caregiver. The member, or their individual representative, may choose to assume one or more of the following employer-based responsibilities: recruiting and selecting caregivers and specifying the qualifications of the caregiver.
Another member-directed option is Self-Directed Attendant Care (SDAC), which has been available to members since 2008. Under the SDAC option, the member or member’s legal guardian serves as the legal employer of the paid caregiver and assumes all employer-based responsibilities. The member or member’s legal guardian is supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding, and paychecks for the caregiver.
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AHCCCS long-term care
AHCCCS, otherwise known as the Arizona Health Care Cost Containment System, is Arizona's Medicaid programme. It provides health insurance to those who are unable to afford it, including seniors and disabled individuals.
The Arizona Long Term Care System (ALTCS) is a long-term care insurance programme under AHCCCS. ALTCS is designed to help seniors and disabled individuals requiring long-term care afford the care that they need. This includes assisted living, in-home care, or residential care. ALTCS pays for the care that an individual needs after their savings are exhausted. The program requires an application, which typically takes between 60 and 90 days for approval. The application process involves two critical assessments: a financial evaluation and a functional and medical assessment. The financial evaluation determines whether the applicant has the monetary means to self-fund the necessary care. The functional and medical assessment assigns points based on need, with a successful application scoring 60 points or more.
ALTCS members living in their own homes have the option of Agency with Choice, where the member or their representative may recruit and select caregivers, specifying the qualifications of the caregiver. Another option is Self-Directed Attendant Care (SDAC), where the member or their legal guardian serves as the legal employer of the paid caregiver and assumes all employer-based responsibilities.
While waiting for an application to be processed, individuals may qualify to receive drug and alcohol and mental health treatment services through other funding sources administered by the Regional Behavioral Health Authority (RBHA).
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AHCCCS for people with disabilities
AHCCCS provides health coverage for people with and without disabilities who have low incomes. If you have a disability, you can qualify for AHCCCS in several ways. Firstly, if you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits due to a disability, you automatically meet the disability requirement. If you don't receive SSI or SSDI benefits, you must be determined disabled by the Social Security Administration (SSA) or AHCCCS. Being designated as disabled by either of these entities may allow you to get AHCCCS even if your income is higher than the standard AHCCCS income limit. Additionally, it may enable you to receive AHCCCS and Medicare simultaneously.
To determine your eligibility for AHCCCS based on your disability, AHCCCS will consider factors such as your family size, earned and unearned income, and whether you have Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs). If you are single with no dependent children, you can use an online tool to check if your income falls below the income limits for at least one of the two tests used by AHCCCS. The two tests have different calculations for countable income, which does not include certain payments like those from TANF Cash Assistance, Section 8 housing, or Nutrition Assistance.
If you have a disability and work, you may be able to qualify for AHCCCS Freedom to Work, which has a higher earned income limit. This option is designed for people with disabilities whose income exceeds the standard AHCCCS limit but still meet the Social Security Administration's definition of disability. Additionally, if your income increases, you can switch to AHCCCS Freedom to Work to maintain your coverage.
To sign up for AHCCCS, you can visit or call your local DES/Family Assistance Administration office, consult a Federally Qualified Health Center, or seek assistance from HealthCare.gov. Work Incentive Consultants are also trained experts who can provide guidance on health programs, work incentives, and disability benefit programs for people with disabilities. They can help you understand how work may impact your benefits and develop a sustainable financial plan.
AHCCCS offers various covered services, including long-term care services provided through program contractors, such as Health Maintenance Organizations (HMOs). Member-directed options are available, like Self Directed Attendant Care (SDAC), where the member or their legal guardian serves as the legal employer of the paid caregiver. Additionally, Agency with Choice allows members living in their own homes to share employer-based responsibilities for the paid caregiver with the provider agency. American Indian members can choose between the American Indian Health Program and AHCCCS Complete Care health plans. While waiting for your AHCCCS application to be processed or if you are deemed ineligible, you may still qualify for drug, alcohol, and mental health treatment services through other funding sources, such as the Regional Behavioral Health Authority (RBHA) or AHCCCS Complete Care-Regional Behavioral Health Agreements (ACC-RBHA).
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Frequently asked questions
AHCCCS stands for Arizona Health Care Cost Containment System, which is Arizona's Medicaid agency that offers health care programs to serve Arizona residents.
AHCCCS offers long-term care services through program contractors, who work with healthcare providers to deliver care. Member-directed options are available to most Arizona Long Term Care System (ALTCS) members who live in their own homes. These options include Self-Directed Attendant Care (SDAC) and Agency with Choice. Under SDAC, the member or their legal guardian acts as the employer of the paid caregiver. Under Agency with Choice, the provider agency and the member share employer-based responsibilities for the paid caregiver.
To be eligible for AHCCCS, individuals must meet certain income and other requirements. You must be a U.S. citizen or meet specific noncitizen requirements. If you are under 65, the eligibility rules are different. If you are 65 or older and are the parent or caretaker of a child, you may be eligible. If you have a disability, there are additional ways to qualify.
