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The Arizona Medicaid Program: AHCCCS (Access Arizona)

AHCCCS, or the Arizona Health Care Cost Containment System (pronounced “access”), is the name for the Arizona Medicaid Program. The program began in 1982 and works with over 70,000 different medical providers in the state of Arizona, providing services for almost two million beneficiaries. The Access Arizona vision is “to shape tomorrow’s managed care...from today’s experience, quality and innovation.” Use this guide to help determine your AHCCCS eligibility status, download the AHCCCS application, and more!

What You Should Know about Arizona Medicaid Includes:

Arizona Health Care Cost Containment System Coverage

If you hear a doctor or anyone refer to “Access Arizona,” they are most likely referring to the Arizona Health Care Cost Containment System. Access Arizona plans work similarly to a marketplace HMO (Health Maintenance Organization) plan. You’ll have to select one primary physician who accepts your plan to be the first doctor you go to for all your health care needs. That one doctor will be the person who authorizes all your medical services and can refer you to specialists for treatment.

AHCCCS provides coverage for adults, caretaker relatives, children, seniors, the blind and disabled, nursing home residents, pregnant women, and other disabled persons who need financial assistance. Covered services include (but are not limited to):

  • Doctor visits (well and sick)
  • Hospital visits
  • Immunizations and prescriptions
  • Labs, x-rays, and tests
  • Medical transportation
  • Emergency services
  • Dental, vision, and hearing for kids
  • Emergency dental for adults
  • Dialysis
  • Mental Health
  • Surgeries

Arizona Medicaid Mental Health

The Arizona Medicaid program has one of strongest mental health benefits of any state health insurance program. Access Arizona plans cover adult day care programs, crisis services, rehabilitation, counseling, testing, and more.

ALTCS Arizona

The Arizona Long Term Care program, ALTCS, contracts with doctors, nursing homes, hospitals, specialists, and pharmacies to help Access Arizona beneficiaries who require long-term care services. Benefits are typically decided on a case-by-case basis and can include nursing facilities, hospice, attendants and private nurses, adult day care, therapy, home-delivered meals, and even dental services.

AHCCCS Providers

To find a doctor, hospital, dentist, or other specialist in your area, use the AHCCCS official provider search tool. Enter your zip code and select the type of provider you are looking for.

Have Questions? Ask a Benefits Advisor in Your Area

AHCCCS Dental, Vision, and Hearing

Dental, vision, and hearing are three benefits that most people don’t normally find within their medical plan. AHCCCS plans provide dental, vision, and hearing only for members under the age of 21. As of 2018, however, adult AHCCCS members now have access to emergency dental coverage. Members over the age of 21 can be covered for up to $1,000 per year in emergency dental care and extractions. Examples of this include emergency crowns due to pain, root canals, etc. - anything that is classified as a medically necessary emergency.

Prescription Drug Coverage and the AHCCCS Formulary

Though most members will face a small copayment, AHCCCS members do have coverage for prescription drugs. If you have Arizona Medicaid but also have drug coverage through Medicare, Medicare will cover your prescriptions first. The AHCCCS formulary (drug list) can tell you what prescription drugs are covered.

Meeting AHCCCS Eligibility Requirements (2018)

AHCCCS eligibility is different based on your age, income, and required services. On the most basic level, you must be an American citizen (or legal immigrant), an Arizona resident, and financially needy. Use the chart below to help figure out if you are eligible for Arizona Medicaid.

Note that if you or your child is under the age of 19 but does not meet the AHCCCS eligibility requirements, kids can still qualify for Arizona KidsCare at 200% of the federal poverty level. KidsCare comes with a premium of anywhere from $10-$70. Reach out to your local Family Assistance Office or call 1-855-HEA-PLUS for more information on KidsCare.

AHCCCS Income Limits Chart

These numbers are from 2018 and correspond with the Federal Poverty Level. The limits are subject to change every year.

Completing Your AHCCCS Application

There are a few different ways that you can complete your AHCCCS application: it’s easy! If you think you may need help completing your application, you can apply by visiting a DES (Arizona Department of Economic Security) office near you or calling Monday through Friday from 8 AM to 5 PM, 1-855-432-7587.

If you feel comfortable completing the AHCCCS application by yourself, visit Health-e-Arizona PLUS to complete your application online.

Download the Arizona Medicaid Application

If you prefer, click here to download the Arizona Medicaid Application. You can keep pages A-G for yourself. Send pages 1 through 6 to the MA-SP office (801 East Jefferson St., Phoenix, AZ 85034).

Have Questions? Ask a Benefits Advisor in Your Area

Choosing From AHCCCS Plans

There are more than ten health plans that you can choose from (less for long-term care plans). All Access Arizona health plans include the same covered services, but they do not all have the same network. That means that not every doctor, hospital, or pharmacy will accept every AHCCCS plan. It may be a good idea to check with your favorite doctors before you select your plan to make sure you do not have to switch doctors.

Not all plans will be available in your area. Click here for the full list of AHCCCS plans that you can choose from. You can filter by county or city to only see the options available to you.

Different AHCCCS Costs

Though you can certainly save a lot of money with an AHCCCS plan, they aren’t entirely free. Some people will have copays for services (depending on your income level). Typically, adults with income over 106% of the Federal Poverty Level (which changes every year) will face copayments. You will not be charged a copay for family planning and pregnancy care, emergency services, or preventative services. Additionally, those under the age of 19, diagnosed with a serious mental illness, enrolled in long-term care, nursing home or hospice residents, and those in the Breast and Cervical Cancer Program will not face copayments.

Access Arizona members with copays will incur the following costs:

  • $4 for prescription drugs
  • $5-10 for doctor visits
  • $2-5 for outpatient therapy
  • $30-50 for non-emergency surgeries
  • $75 per inpatient hospital stay
  • $8 for non-emergency emergency room visits
  • $2 for non-emergency medical transportation (Pima and Maricopa only)

However, there is a cap on copays. You will not be asked to pay more than 5% of your quarterly income on medical copays.

Have Questions? Ask a Benefits Advisor in Your Area

Having both Medicare and Medicaid in Arizona

If you meet the Arizona Medicaid eligibility requirements but are also eligible for AZ Medicare, you can qualify for a dual-eligible special needs plan! To qualify for Medicare, you have to be either age 65 or older, diagnosed with ALS or ESRD, or disabled and receiving Social Security for at least 24 months.

For more information about dual-eligible special needs plans, or DSNPS, click here. To schedule an appointment with an agent who can help you find the right DSNP for you, complete this form or call us at 833-438-3676.

Have questions? Ask a Benefits Advisor!