Building an Integrated Health Care System and Improving Care Coordination

Today’s health care system is a series of parts not yet connected to each other. Improving care coordination and communication, while reducing fragmentation, weaves these parts together to create a health care system with more effective outcomes. AHCCCS continues to integrate the care delivery systems and align incentives that are designed to transform the structure of the Medicaid program, improve health outcomes, and better manage limited resources.

Improving Behavioral Health and Physical Health Care Coordination for Individuals with a Serious Mental Illness Designation

On October 1, 2022, AHCCCS updated its contracts with Managed Care Organizations (MCOs) for health insurance coverage for individuals with a Serious Mental Illness (SMI) designation. Select AHCCCS Complete Care (ACC) Contractors expanded responsibilities as ACC Contractors with a Regional Behavioral Health Agreement (ACC RBHA). The ACC RBHAs are responsible for providing integrated care addressing physical and behavioral health for members with an SMI designation. AHCCCS continues to partner with the ACC RBHAs to identify and implement strategies that enhance the quality and accessibility of care, strengthen the effectiveness of service delivery, and improve overall program efficiency.

Medicare and Medicaid Alignment for Dual Eligibles: Alignment Makes a Difference

Medicare presents one of the greatest challenges to states serving individuals dually eligible for Medicaid and Medicare. Medicare is its own distinct, complex system of care operated by the federal government with little to no interface with state Medicaid programs. For the over 180,000 Arizonans that are eligible for both Medicare and Medicaid, navigating these two separate systems of care can be overwhelming. Under these circumstances, its more likely for people to fall through the cracks, receive inefficient care, and not achieve optimal health outcomes. See the Dual Eligible Members web page to learn how AHCCCS is aligning these systems.

Simplifying the System of Care for Children with Special Health Care Needs: Children’s Rehabilitative Services (CRS)

Children’s Rehabilitative Services (CRS) was started in 1929 to serve children with complex health care needs who require specialized services. Services for the treatment of CRS qualifying conditions were previously managed solely through the CRS program. Medicaid members would then have to access routine or other non-CRS specialty physical health care through their AHCCCS acute plan and behavioral health through the RBHA. For children that were Medicare eligible, the family had one additional hurdle. Arizona families attempting to care for their child with special health care needs was being asked to navigate up to four systems of care. See the CRS web page to learn how AHCCCS is aligning these systems.

Justice System Transitions

AHCCCS partners with state and county governments to improve coordination of care for individuals who are leaving the carceral setting. A significant number of people transitioning out of jail or prison and into their communities need behavioral health and physical health services. Because Medicaid funding may not be used to covered services while a person is incarcerated, their AHCCCS enrollment goes into suspension as opposed to being terminated. Once AHCCCS receives notification that they have been released from the carceral setting, their coverage comes out of suspended status without the need for another application. For individuals who do not already have Medicaid benefits, a growing number of state and local carceral settings have Correctional Assistors on-site to help an individual to apply for benefits through an expedited pre-release application process. AHCCCS is additionally establishing automated processes with multiple state and county partners to improve and hasten this communication, ensuring individuals can access the care they need when they need it, reducing the risk of symptom relapse and recidivism.

The Consolidated Appropriations Act (CAA) of 2023 includes a federal requirement that allows eligible youth to begin receiving certain Medicaid and CHIP services up to 30 days prior to their release from a carceral setting. This advance access strengthens care coordination, supports early engagement with community-based providers, and helps ensure a smoother, more successful transition back into the community.

Additional support for individuals reentering the community is provided through AHCCCS and Managed Care Organizations (MCOs) statewide. Each MCO is contractually required to maintain a dedicated justice system contact, often referred to as a Justice Liaison, who assists in connecting individuals to needed behavioral health resources and community services. Learn more about Support for Individuals Involved in the Justice System.