Families with Children that are no Longer Eligible Due to Earnings - Transitional Medical Assistance (TMA)
If a family is no longer eligible for any AHCCCS program due to higher income that they get from working, they may still get AHCCCS benefits through the Transitional Medical Assistance (TMA) program. Adults on TMA have to pay higher copays for some medical services and will need to pay the copays in order to get the services. If you are on the TMA Program now or if you become eligible to receive TMA benefits later, the notice from DES or AHCCCS will tell you so.
Copayment Amounts for Persons Receiving TMA Benefits
|Doctor or other provider outpatient office visits for
evaluation and management of your care
|Physical, Occupational and Speech Therapies
|Outpatient Non-emergency or voluntary surgical procedures
Pharmacists and Medical Providers can refuse services if the copayments are not made.
A family receiving TMA will not be required to make the copays if the total amount of the copays made is more than 5% of the gross family income (before taxes and deductions) during a calendar quarter (January through March, April through June, July through September, and October through December.)
When a family receiving TMA benefits thinks that they have paid copays that equal 5% of the family's total quarterly income and AHCCCS has not already told them this has happened, they should send copies of receipts or other proof of how much they have paid to AHCCCS, 801 E. Jefferson, Mail Drop 4600, Phoenix, Arizona 85034.
If you think that your income or circumstances have changed, contact your eligibility office right away.
Other Adults - AHCCCS Care Program (Childless Adults)
An adult may get AHCCCS benefits through the AHCCCS Care Program. An adult is on
AHCCCS Care because the adult:
- Does not have an eligible deprived child living with them (see Arizona
Administrative Code R9-22-1427),
- Is not pregnant,
- Is not aged 65 or over, or
- Is not disabled.
People on AHCCCS Care have to pay higher copays for some medical services and will
need to pay the copays in order to get the services.
IMPORTANT: The copays for people in the AHCCCS Care Program may change because of a lawsuit. If there are changes to these copays in the future, AHCCCS will tell you.
Copayment Amounts for Persons on AHCCCS Care Program
|Generic Prescriptions and Brand Name Prescriptions when there is no generic
|Brand Name Prescriptions when there is a generic that can be used
|Non-emergency use of an emergency room
|Doctor office visits
|Taxi ride to obtain medical services (for adults in Maricopa and Pima counties only)
||$2.00 each way
Pharmacists, medical providers, and taxi companies can refuse services if the copayments are not made.
If your circumstances have changed and you don't think you belong in the AHCCCS Care program, contact your eligibility office to ask them to review your eligibility.