Federal Activities


State Innovative Model Grant

July 1, 2014
AHCCCS will be applying for the State Innovative Model Grant, Round Two. The initiative provides support and funding for state multi-payer efforts around payment reform and health care system transformation to improve health, transform the delivery system, and lower costs. The Initiative provides funding for states to either design or test health care innovation models. More information can be found on the link below.
SIM Grant Info


Provider Changes 1/1/12

Tue Dec 20, 2011
Effective January 1, 2012, the AHCCCS Office of the Inspector General will implement program integrity changes as required by the Affordable Care Act and published in the CMS final rule [PDF] related to:

  1. Provider Registration and
  2. Suspension of Provider Payment based on a Credible Allegation of Fraud.

The link below has more information.

Provider changes 1/1/12


QI-1 Program Updates

January 2, 2013
As a result of recent Congressional action, increased federal funding for the QI-1 program was made available and AHCCCS will open the program effective immediately. All applications that were previously denied because the program was scheduled to expire December 31, 2012, will now be processed. Also, QI-1s who were previously notified their QI-1 benefits were ending, will be reinstated effective January 1, 2013.

December 13, 2012
Pursuant to Section 1933 of the Social Security Act, the AHCCCS Administration will institute an enrollment freeze for persons who would otherwise be eligible for benefits as "qualifying individuals" or "QI-1s." Although QI-1s are a mandatory eligibility group, subsection (b)(3) of section 1933 of the Act requires the State to limit the number of QI-1s made eligible for the calendar year so that the amount of assistance provided to such individuals is estimated to equal but not exceed the State's federal allocation for the QI-1 population. Due to insufficient federal funding, AHCCCS will be denying new and pending applications for QI-1s as of December 14, 2012. Also, current QI-1 members will be notified the week of December 17th, that AHCCCS will discontinue their benefits effective December 31, 2012 due to insufficient federal funding. AHCCCS will continue to monitor whether Congress will authorize additional federal funding for the QI-1 population for the remainder of 2012 and in the future.

QI-1 Letter 12/14/12 [PDF]

QI-1 Member Letter Update [PDF]
QI-1 Program History


Planning Begins for Specialty RBHA with SMI Health Home

Fri Jul 15, 2011
In March 2011, AHCCCS and ADHS/DBHS applied for, and were awarded, a planning grant to explore the feasibility of a specialty Regional Behavioral Health Authority (RBHA) model with expanded responsibility for Title XIX eligible adults determined to have a Serious Mental Illness (SMI). The "Specialty RBHA with SMI Health Homes" model would be funded and fully responsible for coordinated and integrated behavioral healthcare and physical healthcare for Title XIX eligible adults with SMI through the use of SMI health homes.

The ADHS/DBHS website provides additional information on the Specialty RBHA concept, along with background information on integration of care, and how consumers and stakeholders can participate. AHCCCS will also post updates as information becomes available.

Update on Medicare Part B Premiums

Fri Oct 21, 2011
CMS approved Arizona's request for flexibilities under the 1115 Waiver to provide coverage for the cost of Part B premiums after October 1, 2011. Pursuant to authority in the Waiver, AHCCCS will continue to pay the Medicare Part B premiums for certain AHCCCS members. A link to the approval letter is provided below.

CMS Approval Letter [PDF]

Thur Jul 7, 2011
As a result of an OIG audit and CMS decision, payment of the Medicare Part B premium for approximately 10,000 ALTCS members whose income exceeds 120% of the Federal Poverty Level (FPL) will be terminated by AHCCCS and will become the member’s responsibility effective October 1, 2011. See the links below for more information.


Health Care Reform Passed by Congress

Updated information on the status and impact of Health Care Reform, is available on the link below. Information on this page provides useful background based on various proposals and documents Arizona’s tracking of these issues. Please visit the AZ Future page for the most recent data and updates.
AZ Future Page

  1. AHCCCS Update Regarding Health Care Reform

    Thu Jan 26, 2012
    AHCCCS has updated its analysis on Medicaid expansion scheduled to be effective January 1, 2014, pursuant to the Affordable Care Act (ACA). Note, these estimates are based on information available at this time and should not be considered definitive as there remains a number of uncertainties. Federal guidance regarding a number of issues is forthcoming and is expected to have an impact on these estimates. Continue to check the website for updates to this information.

    ACA Prelim Estimates [PDF]

    Fri Feb 4, 2011
    Information regarding AHCCCS implementation of some of the Medicaid provisions of the Affordable Care Act (ACA) [PDF] is provided below. This document will be updated regularly as information becomes available.

    AHCCCS Activities- 5/13/11 [PDF]

    Thu Mar 25, 2010
    On March 23, 2010, President Obama signed federal health care reform into law (HR 3590 [PDF]). On March 25, the Senate passed the House amendments to HR 3590 via the Reconciliation bill (HR 4872 [PDF]), which was sent back to the House for a second vote on a procedure change. The House passed the Reconciliation bill a second time that same evening and now the bill awaits President Obama's signature, which is expected sometime next week. AHCCCS has completed its initial review of the impact to Arizona and has updated the fiscal estimates from the December 7, 2009, analysis. Copies of the AHCCCS preliminary analysis and the bills are provided below:

  2. New Grant Opportunity

    Fri Mar 18, 2011
    The Centers for Medicare & Medicaid Services (CMS) is inviting proposals from State Medicaid agencies to compete for grant awards for the Medicaid Incentives for Prevention of Chronic Diseases Program. CMS is conducting a nationwide program to test and evaluate the effectiveness of a program to provide financial and non-financial incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. The initiatives or programs are to be "comprehensive, evidence-based, widely available, and easily accessible." The programs must use relevant evidence-based research and resources, including: the Guide to Community Preventive Services; the Guide to Clinical Preventive Services; and the National Registry of Evidence-based Programs.

    AHCCCS is reviewing this grant opportunity as part of an overall effort to reform the Medicaid program for Arizona. Any interested organization wishing to partner with AHCCCS or submit a concept for consideration may do so at IncentiveGrantPartner@azahcccs.gov. Because state Notices of Intent are due to CMS by April 4, 2011, AHCCCS is requesting that external stakeholders submit their concepts to AHCCCS no later than 6:00p.m., MONDAY, MARCH 28, 2011. Please limit submissions to two pages and include: (1) a brief description of the concept; (2) citations to evidence-based research supporting the concept; and (3) a representation of the anticipated workload for AHCCCS in implementing the concept.

    AHCCCS will review all concepts submitted and make a final determination as to whether the agency will pursue the grant. If the agency pursues the grant and adopts any of the concepts submitted, those entities will be notified in advance. AHCCCS will post the Notice of Intent and any final grant application, if pursued, to its website.

    For more information about this grant opportunity, please visit: http://www.cms.gov/MIPCD/.

  3. Health Homes for Enrollees with Chronic Conditions

    On March 29, 2001, CMS approved Arizona's planning request for the funding opportunity provided under Section 2703 of the Affordable Care Act- "Health Homes for Enrollees with Chronic Conditions." As detailed in the request, Arizona is interested in determining the feasibility of developing integrated health homes for persons with Serious Mental Illness.

  4. Integrated Care for Dual Eligbles

    Fri Feb 4, 2011
    AHCCCS applies for a contract to develop an innovative model for improving the integration of care for dual-eligible members. See contract submission here:

    Integrated Care for Dual Eligibles [PDF]

  5. Recovery Audit Contractors

    Tues Dec 7, 2010
    Section 6411 of the Affordable Care Act [PDF] requires states to contract with Recovery Audit Contractors (RACs) to identify underpayments and recoup overpayments for services paid by Medicaid.  Recovery Audit Specialists, LLC., is the state-wide contractor for cost recovery services and will serve as the RAC for Arizona.  More Information can be found on the link below:
    Recovery Audit Specialists Info [PDF]

  6. Governor Brewer's Letters Regarding Health Care Reform

    Governor Brewer has shared her concerns about Arizona's challenges with Health Care Reform to Congressional leaders. Links and descriptions of those letters are provided below, beginning with the most recent.

  7. Impact on the KidsCare Program

    Tues Dec 28, 2010
    AHCCCS continues to work with CMS on issues related to the KidsCare program, including the impact of the Enrollment freeze.

    For additional information about the Enrollment cap visit: http://www.azahcccs.gov/reporting/legislation/sessions/2009/fifth.aspx

    Mon Jun 28, 2010
    AHCCCS has received guidance from CMS regarding the impact of the Affordable Care Act (ACA) [PDF] on the KidsCare program.

    Thu Mar 18, 2010
    Effective June 15, 2010, the KidsCare program will end. KidsCare is Arizona's Children's Health Insurance Program and covers children whose families have income between 100% and 200% of the Federal Poverty Level (FPL). The State does not have enough funds to keep paying its portion of this program. This program was funded jointly by the State and federal government under Title XXI of the Social Security Act. There are about 38,000 children currently enrolled in the program.

    Loss of KidsCare or AHCCCS Health Insurance is now a qualifying event for an employer's group health plan. See the Federal Activities page for more information.

    AHCCCS has submitted the following notice to CMS:

    AHCCCS Notice to CMS Regarding KidsCare Termination - 3/18/10 [PDF]

  8. High Risk Pools

    Fri Jul 2, 2010
    The Pre-existing Condition Insurance Plan (PCIP) was established by the U.S. Department of Health and Human Services (HHS). The PCIP offers health coverage through 2014 to qualified individuals who can not get health coverage because of a pre-existing health condition. After 2014, insurers will be required to provide access to more affordable private insurance via the new Exchanges as described in the Affordable Care Act [PDF]. Applicants in Arizona will be linked directly to the federal application page since the HHS is running the PCIP for Arizona. More information about the PCIP and how to apply is available at: www.HealthCare.gov.

    PCIP Pamphlet [PDF]

    Wed May 5, 2010
    The Affordable Care Act (ACA) [PDF] establishes temporary high risk pools beginning June 21, 2010. The ACA allows states to either operate their own risk pool or opt out and allow their state's citizens to access a federally operated risk pool. In a recent letter to HHS Secretary Sebelius, Arizona elected to opt out. More information about the federal government's plans to implement and operate the temporary high risk pools in Arizona will be provided as soon as it is received.

    Governor Brewer's Letter to HHS - 4/30/10 [PDF]

  9. Medicaid Provisions

    Mon Apr 19, 2010
    AHCCCS has summarized the various Medicaid provisions of health care reform from the Affordable Care Act [PDF]. Please note, other sections not included in the matrix may be added at a later date. Information will be updated as it is available.

    Health Care Reform Matrix [PDF]

  10. Reform Proposals
    • President's Proposal

      Mon Feb 22, 2010
      President Obama unveiled key provisions of his proposal for health care reform. AHCCCS is in the process of reviewing the provisions, although the documents currently available do not provide significant detail to allow for a thorough impact analysis. More information will be posted as it becomes available.

      President's Proposal [PDF]

      Governor's Letter to President Obama - 3/10/10 [PDF]

    • Senate Proposal

      Thu Dec 24, 2009
      The Senate passes The Patient Protection and Affordable Care Act (H.R. 3590), the Senate vehicle for health care reform legislation.

      Senate Proposal [PDF]

    • House Proposal

      Sat Nov 7, 2009
      The House of Representatives passes The Affordable Health Care for America Act (H.R. 3962).

      House Proposal [3.2MB]

  11. AHCCCS Analysis

    Fri Jan 29, 2010
    On January 27, 2010, AHCCCS made a presentation about Federal Health Care Reform to the Arizona House and Senate Health Committees. A copy of the presentation is provided below:

    AHCCCS Federal Health Care Reform Update [PDF]

    AHCCCS recently sent a letter to the Governor outlining the Agency's assessment on the impact that Congressional health reform proposals will have on the Arizona state budget and Medicaid program.

    Letter to the Governor Outlining the Impact of Federal Health Care Reform Proposals [PDF]

    The presentation below provides the Agency's analysis regarding the potential impact of the federal health care reform proposals to Arizona. Please note, following December 18, 2009, when the presentation was created, the U.S. Senate made changes to its proposal that are not reflected in the presentation. AHCCCS will continue to monitor the impact to Arizona as information becomes available. Updated information about changes to the proposals can be found on the website of the Kaiser Family Foundation.

    Federal Health Care Reform Analysis and Update [PDF]

  12. News Coverage

    Information about the impact of Federal Health Care Reform to Arizona has appeared in recent media outlets.

    On December 30, 2009, the Governor issued the following statement regarding the financial impact of the Federal Health Care Reform plan.

    Governor's Statement Regarding HCR [PDF]

New FPL Limits Effective April 1, 2011

Tue Mar 1, 2011
The new Federal Poverty Level limits effective April 1, 2011 are now available:

2011 Federal Poverty Guidelines [PDF]

Tue Mar 16, 2010
On January 22, 2010, the Federal register published a notice to advise that the 2009 poverty guidelines will remain in effect until updated 2010 poverty guidelines are published. To date, the 2010 poverty guidelines have not been published. AHCCCS will post information as soon as it becomes available. A copy of the Federal Register notice is provided below:

Federal Register Notice - 1/22/10 [PDF]

UPDATE: The Federal register did not publish new poverty guidelines in 2010. There were no increases in 2010 to the FPL.

Federal Medical Assistance Percentage (FMAP) Extension

Tue Aug 17, 2010
On August 10, 2010, President Obama signed HR 1586, which includes an extension of $16 billion in increased Medicaid funding to states through June 30, 2011. It is anticipated that Arizona's general fund will benefit by $246 million in Medicaid funding but leaves about $150 million short for FY 2011. The complete loss of stimulus dollars for FY2012, which begins July 1, 2011, will leave a $1 billion shortfall for FY 2012. More information will be posted as it becomes available.

HR 1586 [PDF]

Children's Health Insurance Program Reauthorization Act (CHIPRA)

On February 4, 2009, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Public Law 111-3) was signed into law. CHIPRA reauthorizes and finances the Children's Health Insurance Program (CHIP) through FY 2013 and made other changes to the CHIP and Medicaid programs. More information is provided below:

  1. CMS Denies Arizona's Application for KidsCare Bonus Payments

    Section 104 of the Children's Health Insurance Program Reauthorization Act (CHIPRA) provides for a performance bonus payment to states that meet five of eight enrollment and retention provisions for children. CMS informed AHCCCS that it was deficient in two of the provisions to qualify for performance bonus payments. Below is additional information regarding Arizona's appeal of the CMS decision that the state does not meet five of the eight requirements to qualify for performance bonus payment.

    It is estimated the State would have received approximately $31.7 million over 3 years to help sustain its KidsCare program.

  2. Loss of KidsCare or AHCCCS Health Insurance a Qualifying Event

    The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 made several changes designed to help people get or keep health insurance coverage. One of the changes allows employees and their families to enroll in their employer's group health plan without having to wait for an open enrollment period when the employee or dependent loses their AHCCCS or KidsCare benefits. The employee or dependent must:

    • Be eligible to sign up for health insurance through their employer. For example, some employers only offer health insurance to employees who work 30 hours a week or more. Someone who works only 24 hours per week would not be eligible in this example; and
    • Ask to enroll with the employer's group health plan within 60 days from the date the AHCCCS or KidsCare coverage ends.

    Contact your employer immediately if you think you may be eligible to enroll in their group health plan coverage and your AHCCCS or KidsCare coverage is ending. More information is available from CMS: Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009, Section 311

For additional information about CHIPRA, visit the CMS website: http://www.cms.hhs.gov/chipra/

American Recovery and Reinvestment Act (ARRA)

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA)(P.L. 111-5). Title 5 of the ARRA provides approximately $87 billion in grant money to help States, the District of Columbia, and Territories meet the health care needs during the economic crisis.

Information on how the ARRA would impact Arizona's Medicaid program is provided below:

For additional information about ARRA and Medicaid, visit the CMS website: http://www.cms.hhs.gov/Recovery/09_Medicaid.asp

CRS Administrative Changes

Tue Oct 5, 2010
On January 1, 2011, the administrative oversight for the Children's Rehabilitative Services (CRS) program will be consolidated in AHCCCS. There will be no change in how members and families interact with their health plan, providers, network or service package
Member Notice [PDF]


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