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Transitions out of the Criminal Justice System

Enrollment Suspense IGA

AHCCCS is engaged with the Arizona Department of Corrections (ADOC) and most of Arizona’s counties, including Maricopa and Pima, in a data exchange process that suspends AHCCCS enrollment upon incarceration, instead of terminating coverage. This exchange allows ADOC and counties to electronically send discharge dates for AHCCCS members, which simplifies the process of transitioning members directly into care. Through this enrollment suspension process, care can be coordinated by county jails or prisons upon discharge for over 95% of members involved in Arizona’s criminal justice system.

Inmate Enrollment Suspension Technical Document

Hospital Inpatient IGA

AHCCCS has intergovernmental agreements in place with the majority of counties in AZ (including Maricopa and Pima) and ADOC to provide services to people in detention who are admitted temporarily into an inpatient hospital setting. This process includes a determination of eligibility for AHCCCS. When a detainee is released from custody temporarily to an inpatient hospital setting, designated staff assist the detainee with completing an application for AHCCCS Health Insurance. The application is submitted to a special unit that determines AHCCCS eligibility for the specific period of the hospital stay. When the detainee is determined eligible, the hospital will submit a bill to AHCCCS to pay for the brief hospital stay.

Pre-Release Applications

ADOC and multiple most AZ counties (including Maricopa, Pima and Navajo) submit pre-release applications via HEAplus for AHCCCS Health Insurance approximately 30 days before detainees are released from incarceration. If additional information is required, These applications are submitted to special units at AHCCCS and the Department of Economic Security (DES) for review and processing assist. Staff in these special units review the applications for eligibility and approvals become effective when the applicant is released from custody. Submission of applications prior to release helps to ensure that people who need critical care are enrolled in AHCCCS immediately upon their release.

Individuals who are at risk of needing an institutional level of care upon their release, receive a pre-admission screening while incarcerated and have a Medicaid application completed. When eligible, the member is connected to the Arizona Long Term Care System (ALTCS) program and placed into a long-term care setting immediately upon their release.

Care Coordination

All AHCCCS Managed Care Organizations (MCOs) are contractually required to provide “reach-in” care coordination to identify members with complex health needs prior to their release from incarceration. MCOs (including Regional Behavioral Health Authorities (RBHAs)) connect case managers to members pre-release to provide information and schedule appointments with primary care physicians and behavioral health providers, as appropriate.

More information about the Justice System Transitions can be found below: