The Handbook for Members of the American Indian Health Program and/or the Tribal Regional Behavioral Health Authorities

August 2023

Table of Contents
Advance Directives	24
Am I Covered Outside of Arizona?	10
American Indian Medical Home	9
Behavioral Health and Crisis Hotlines	21-23
Children - Services for Children	15
Community Resources	27
Dental Services	18
Dialysis Services	19
Emergency Care	14
Emergency Transportation	14
Enrollment Options	8
Family Planning Services	17
Fraud and Abuse	24
Grievances and Appeals	12
Having a Baby	18
Hospital Inpatient Services	17
Hospital Outpatient Services	17
Hysterectomy Services	18
ID Cards	4
Immunizations	16
Long-Term Care Services (ALTCS)	23
Medicines	23
Notice of Non-Discrimination	25
Office Visits	15
Other Insurance	24
Phone Numbers	6
Podiatry Services	19

Preventative Care	15
Personal Information	4
Prior Authorization	10
Provider Directory	9
Rehabilitative Services	19
Rights and Responsibilities as a Member	11
Services AHCCCS Will Pay For (Covered Services)	13
Transportation (Non-Emergency Medical Transportation)	20
Transportation from a Hospital to another Facility	20
Vision Services	20

Personal Information
My AHCCCS ID number: 	
My Doctor: 	
My Doctor’s phone number: 	
My Pharmacy: 	
My Pharmacy’s phone number: 	
My Pharmacy’s address:	
My Behavior Health Provider: 	
My Behavior Health phone number: 	

Welcome to AHCCCS

Founded in 1982, the Arizona Health Care Cost Containment System (written as AHCCCS and pronounced 'access') is Arizona's Medicaid program. Our mission is to reach across Arizona to provide comprehensive, quality health care to those in need. Our first care is your health care. Thank you for choosing the American Indian Health Program, we will work with you to help you stay healthy.

Please keep this Member Information booklet in a place where you can find it easily.

ID Cards
When you become a member of the AHCCCS American Indian Health Program (AIHP), you will receive an ID card from AHCCCS.

Always carry your ID card with you. You will need to show this card when you get medical care.

When you get your card, make sure your information is correct. If there is a problem with your card or if you lose your card, please call AHCCCS Division of Member and Provider Services.

When ordering a new AIHP ID card you will first speak with the AHCCCS Virtual Assistant (AVA). AVA helps customers via web/chat or voice/telephonic and provides 24/7 service. To request your card, you must speak to an agent.

Phone: 602-417-7100
Visit AHCCCS online at https://www.azahcccs.gov/.

These steps will get you to the call queue for an available agent as quickly as possible:

Call AHCCCS, AVA will greet you,
Tell AVA immediately, “I want to speak to an agent,”
She will ask if there is anything else she can help you with, you say “No, I want to speak to an agent,” and
You will then be placed in a call queue for the next available representative to request your AIHP ID card.

IMPORTANT!
Do not let anyone else use your ID card!

Phone Numbers

If you need emergency care,
go to the nearest emergency room (ER) or Dial 911.

AHCCCS Division of Member and Provider Services

800-962-669
In Maricopa County, call

602- 417-4000

Crisis services are available to any Arizona resident, regardless of health insurance coverage. If you or someone you know is experiencing a behavioral health crisis, please call one of these national or local crisis lines:

Enrollment Options
As an American Indian or Alaskan Native (AI/AN) member, you can receive physical and behavioral health services. Your enrollment choice may affect what services are covered and what providers are in your plan’s network.

You have the option to choose a health plan and may enroll in either:
The AHCCCS American Indian Health Program (AIHP), or
The AHCCCS Complete Care (ACC) plan of your choice.
A list of ACC plans can be found on the AHCCCS website at: AHCCCS Available Health Plans

You may switch your enrollment between AHCCCS AIHP and an AHCCCS Complete Care plan.

To change from American Indian Health Program to a managed care health plan, call 602-417-7000 (Maricopa County) OR 1-800-962-6690 (Outside Maricopa county).
To change from a health care plan to American Indian Health Program, the American Indian Health Program (AIHP) Change Request Form must be submitted to AHCCCS. Only AHCCCS registered Indian Health Service (IHS), Tribally owned/and or operated 638 facilities and Urban Indian Health Organizations (receiving Title V funding from IHS) may use this form.

	Tribal Regional Behavioral Health Authority (TRBHA)	

You may enroll to receive your behavioral health care through a Tribal Regional Behavioral Health Authority (TRBHA). You may only choose a TRBHA if you live within the geographic service area the TRBHA serves.

	A list of TRBHAs can be found on the AHCCCS website at: Tribal Regional Behavioral Health Authorities (TRBHAs)

Refer to your AHCCCS Medical Identification Card to identify your behavioral health coverage.

If you are unsure about your choices or have questions about how your behavioral health services are coordinated, contact AHCCCS Clinical Resolution Unit at 602-364-4558

*** Members with a Serious Mental Illness (SMI) designation may receive behavioral

health care through either a TRBHA, AIHP, or an AHCCCS Complete Care plan with a Regional Behavioral Health Agreement (ACC-RBHA). Additional information regarding SMI determination can be found on page 17.

Where Can I Get Health Care Services?

Regardless of health plan enrollment, physical and behavioral health services may be received at any Indian Health Service (IHS) or tribally owned and/or operated (638) facility.

If you are enrolled in the AIHP you may also receive services at any AHCCCS- registered provider that sees fee-for-service members.
If you choose an AHCCCS Complete Care (ACC) plan you are still able to receive physical and behavioral health services from IHS/638 facilities. In addition, you can receive services from any provider that is a part of your ACC plan’s network.
If you are unsure which providers are in your ACC plan’s network, you can contact your ACC plan.

Provider Directory

The Provider Directory is a searchable listing of AHCCCS registered providers by Specialty. Call the provider’s office and verify if they accept AIHP prior to scheduling an appointment.
To search for a provider, you can click the drop-down arrow on Specialty to select All or a specific type of Specialty, such as an Audiologist or Pediatric Psychiatrist. When you search, a listing of AHCCCS registered providers will appear and the provider’s Name, Specialty, Address and Phone number will be listed. Providers with multiple office locations will be listed under each location.
The searchable online provider directory is available on our website: AHCCCS Registered Provider Listing. You can narrow your search by ZIP code or city.

American Indian Medical Home
As an added benefit to choosing AIHP as your health program, AIHP members may choose to be part of an American Indian Medical Home (AIMH). An AIMH is a registered IHS/638 facility that provides primary care case management services and can provide you access to a care team 24 hours/7 days a week. Members may choose any IHS/638 facility that is a registered medical home. Find the list of American Indian Medical Homes on the AHCCCS website below.

American Indian Medical Home

If you choose an AIMH, a nurse care manager will be assigned to you to help coordinate all your health care appointments.

The AIMH program is a voluntary program. AIHP members who choose to participate, may leave the program or change enrollment with AIMH sites at any time. AIHP members can sign up at the AIMH facility of their choice or call AHCCCS’ Division of Member and Provider Services to request enrollment.

Ask First

	When is Prior Authorization Needed?	

To receive some services from a provider that is not a part of the IHS or a tribal facility, you first must have approval from your health plan (this would be AIHP). This is called prior authorization. The need for prior authorization will depend on your health plan and other requirements. If you are enrolled in AIHP, this authorization comes from the AHCCCS administration.

If you are in the American Indian Health Program (AIHP) and/or enrolled in a TRBHA, your health care provider should contact AHCCCS before you receive the following services:

Non-emergency medical or behavioral health inpatient admissions including admission to a Residential Treatment Center for children and adolescents,
Admission to a Behavioral Health Residential Facility (all ages),
Non-emergency and elective surgeries,
Nursing home placements,
Home health services,
Non-emergency transportation over 100 miles (one-way or round trip),
Medical equipment and medical supplies,
Hospice services, and
Medically necessary eyeglasses for adults.

Members enrolled in an AHCCCS Complete Care (ACC) plan should contact the ACC plan with questions about prior authorization. Health Plan contact information can be found on the AHCCCS website.

Am I Covered Outside of Arizona?
As an AIHP and/or TRBHA member you may be covered by AHCCCS if you are temporarily out of the state, but still an Arizona resident. You may receive services if:

Medical services are needed because of a medical emergency,
You need treatment that you can only get in another state, or
You have a chronic illness, and your condition must be stabilized before returning to Arizona.

Rights & Responsibilities as a Member
Members have certain rights and responsibilities. It is important that you understand each one. Your rights as a member are to:
Be treated with respect and with recognition of your dignity and need for privacy,
Not be discriminated against in the delivery of health care services based on race, ethnicity, national origin, religion, gender, gender identity, age, behavioral health condition, intellectual or physical disability, sexual orientation, genetic information, or source of payment,
Receive an annual member handbook and provider directory,
Have services provided in a culturally competent manner,
Have the opportunity to choose a Primary Care Provider (PCP),
Have the right to refuse treatment and services,
Participate in decision-making regarding your health care,
Be provided with information about formulating Advance Directives,
Receive information in a language and format that you understand,
Be provided with information regarding grievances, appeals, and requests for hearing,
Have the right to complain about the health plan, TRBHA, and/or provider,
Have access to review your medical records in accordance with applicable Federal and State Laws,
Have the right to request and receive annually, at no cost, a copy of your medical records,
Have the right to amend or correct your medical records,
Have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, and
Have the right to be free from and report any perceived intimidation, manipulation and/or coercion that may have occurred while receiving services from an AHCCCS Provider.

Your responsibilities as a member are to:
Share information,
Show your member ID card or identify yourself as an AHCCCS member to health care providers before getting services,

Ask your provider to explain if you don’t understand your health condition or treatment plan,
Give your health care providers and case managers all the facts about your health
problems, past illnesses, hospital stays, all medications, shots and other health concerns,
Follow instructions that you and your health care providers have agreed on, including the instructions of nurses and other health care professionals,
Schedule appointments during office hours, when possible, instead of using urgent or emergency care, and
Keep appointments and come on time. Call your provider’s office ahead of time when you cannot keep your appointments.

Grievances and Appeals
Members enrolled in the American Indian Health Program (AIHP), have the right to file a grievance, make a complaint, or file an appeal.
An appeal is a request from an applicant, member, provider, health plan, or other approved entity to reconsider or change a decision, also known as an action. An action includes any denial, reduction, suspension, or termination of a service or benefit, or a failure to act in a timely manner. An appeal is the formal procedure asking us to review the request again and confirm if our original decision was correct.
Examples of actions:

Denial of request for surgery
Denial of a request for a wheelchair
Denial of basic health care services
Denial or discontinuance of AHCCCS eligibility

Process to File an Appeal

All appeals need to be in writing. Appeals related to denials, discontinuances, or reductions in medical services must be sent to the AHCCCS Office of the General Counsel.
To request an appeal, write the AHCCCS Office of the General Counsel:

Office of The General Counsel
Arizona Health Care Cost Containment System Administration (AHCCCS)

801 E. Jefferson St., MD-6200 Phoenix, AZ 85034 FAX: 602-253-9115
Standard Appeal

During the appeal process, you may submit additional supporting documents or information that you believe would support a different outcome and decision.
After we review your appeal, we will send you our decision in writing within 30 days of the date we received your appeal request.
Request an Expedited Appeal

A request for an expedited appeal can be made if the member or doctor feels that the person's health will be in serious jeopardy (serious harm to life or health or ability to attain, maintain or regain maximum function) by waiting 30 days for a decision. If the appeal is expedited, AHCCCS should resolve the appeal within three working days, absent an extension.
Continuing Services During an Appeal

Members currently receiving services or benefits may be able to continue to receive them during the appeal process. If services or benefits were reduced, suspended or terminated, a request to continue receiving services during the appeal may be made. The appeal must be filed before the day the reduction, suspension or termination is to take effect. If there is less than 10 days between the notice date and the effective date on the notice, the request for continued services must be filed within 10 days from the notice date. If the appeal is denied, the member may have to pay for the services received during the appeal process.
Request a Hearing (after an unfavorable appeal)

If the AHCCCS decision on the appeal is unfavorable, a hearing referred to as a State Fair Hearing, where the appeal is presented before an administrative law judge, may be requested. A written request for a State Fair Hearing must be filed with the Office of the General Counsel.

What Services Will AHCCCS Cover?
AHCCCS covers medically necessary preventative, acute and behavioral health care when it is provided by an AHCCCS registered provider. AHCCCS also offers limited coverage of rehabilitative services, home health care, and long-term care services. Additional covered services are available for members under the age of 21 under the Early and Periodic Screening,

Diagnosis, and Treatment (EPSDT) program.

If you have questions about whether a service is covered, please check with your health care provider. Your health care provider can contact AHCCCS to verify whether a service is covered.

Children with a Children’s Rehabilitative Services (CRS) designation have their physical and behavioral health services covered under AIHP. Members may choose to receive care through the Multi-Specialty Interdisciplinary Clinic (MSIC), IHS/638 facilities or Urban Indian Health Programs (ITUs) or other AHCCCS registered providers.

Emergency Care
AHCCCS covers emergency care 24 hours a day, 7 days a week, both in-state and out of state. An emergency is when something happens suddenly, with serious symptoms. Some examples of an emergency are:

Chest pain
Car accident
Bleeding
Problems breathing
Poisoning
Broken bones

If you need emergency care,
go to the nearest emergency room (ER) or Dial 911.

Emergencies can lead to disability or death if not treated, so seek care immediately.

Prior authorization is not required for emergency care. If there is an emergency CALL 911.

Emergency Transportation

Transportation to the nearest appropriate facility for emergency services is covered 24 hours a day, 7 days a week. CALL 911.

You do not need prior authorization for emergency transportation. If there is an emergency CALL 911.

Preventative Care
AIHP pays for health assessments, screening tests, immunizations, and health education such as, but not limited to:

Well Exams and Physical Exams
Laboratory Tests
Cancer Screenings
Breast (mammogram)
Cervical (Pap tests)
Colon (colonoscopy)
Prostate (PSA test)
Heart Disease Screenings
High blood pressure screening
Cholesterol screening
Other Diseases
HIV screening
Sexually transmitted infections screening
Tuberculosis screening

AHCCCS does not pay for:

Physical exams needed by outside public or private agencies such as:
Exams for insurance,
Pre-employment physical examinations,
Sports exams or exams for exercise programs (except for children under the age of 21),
Pilot’s examinations,
Disability exams, or
Evaluation for lawsuits.

Office Visits
AIHP pays for medically necessary office visits for the diagnosis and treatment of illness and injury.

Services for Children
AIHP pays for health care for members under age 21 through the wellness visits of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. This program helps keep your children healthy.

Children should be seen by their healthcare provider for routine wellness visits and dental checkups.

Wellness visits include:
Health, nutrition, and developmental history,
Screening for immunizations,
Laboratory tests,
Vision, speech, and hearing screening,
Dental screening, and
Behavioral health screening.

The EPSDT Periodicity Schedule is intended to meet reasonable and prevailing standards of medical and dental practice and specify screening services at each stage of the child's life. The service intervals represent minimum requirements. Any services determined by a Primary Care Provider (PCP) to be medically necessary shall be provided, regardless of the interval.

Immunizations
AIHP pays for recommended immunizations for adults and children. Covered immunizations include, but are not limited to:

Diphtheria-Tetanus-Pertussis (DTP),
Influenza,
Pneumococcus,
Rubella,
Measles,
Hepatitis B,
Covid-19,
Pertussis, as currently recommended by the Centers for Disease Control and Prevention (CDC) or ACIP,
Zoster vaccine, for members 60 and older,
HPV vaccine, for females and males up to age 26 years, and
All child and adolescent immunizations, as recommended by the CDC childhood immunization schedules.

All children can get immunizations under the Vaccines for Children (VFC) program.

Hospital Inpatient Services
AIHP pays for medically necessary inpatient hospital care in AHCCCS registered hospitals. This can include IHS/638 facilities.

Covered services include, but are not limited to:
Routine (regular) hospital care,
Intensive care,
Intensive care for newborns,
Maternity care, including labor and delivery, recovery rooms, and birthing centers,
Nursery for newborns and infants,
Surgery, including anesthesiology, and
Emergency services.

Outpatient Services

AIHP pays for AHCCCS covered medically necessary outpatient treatment and surgeries. Your health care provider may need to obtain approval (prior authorization) from AHCCCS before services are rendered.

Family Planning Services
AIHP offers family planning services, which help you to decide if and when you want to have a baby.

AHCCCS will pay for:
Birth control counseling (advice), exams, medicines, and supplies such as:
Pills,
Shots,
Diaphragms,
Intrauterine devices (IUDs), and
Foams.
Voluntary permanent sterilization, and
Natural family planning education or referrals.

AHCCCS will NOT pay for:
Infertility diagnosis or treatment, or
Pregnancy Termination, unless:

The pregnancy termination is medically necessary according to the medical judgment of an AHCCCS registered licensed physician, and/or
The pregnancy was a result of rape or incest.

Having a Baby
As soon as you know that you are pregnant, you should set up your first visit with a provider that specializes in caring for pregnant women such as an obstetrician (OB) or a midwife. The sooner you see your provider, the more likely you will have a healthy pregnancy and baby.

AHCCCS wants to make sure that your baby has the best chance to be strong and healthy. Your provider will set up a visit plan for you, which will include a schedule of your prenatal visits.

The provider will talk about:
Eating healthy foods, taking vitamins, and what to avoid during your pregnancy,
What to expect as the baby grows inside of you and when it is born, and
What tests you should have to make sure both you and the baby are healthy.

Hysterectomy Services
AIHP pays for medically necessary hysterectomies. This is covered only if there is a medical need, according to a medical provider.

Note: You and your provider must sign a hysterectomy consent form before this is done.

Dental Services
AIHP covers dental services provided by an AHCCCS registered dentist. Covered Dental Services for children under 21 years of age include:
Check-ups and sealants (prevention against cavities),
Emergency dental services, and
All medically necessary therapeutic dental services, including fillings.

AHCCCS covers medical and surgical services furnished by a dentist for adults 21 years of age and over only to the extent that such services:
Are emergency dental services, up to $1,000 annual limit, or

Are medically necessary treatments prior to a transplant, or
Are medically necessary treatments prior to cancer treatments (cancer of the jaw, neck or head).

Medically necessary diagnostic, therapeutic and preventive dental services provided at IHS/638 facilities are not subject to $1,000 limit.

Dialysis Services
When a person experiences kidney failure, a dialysis treatment may be needed to clean the blood. AIHP pays for dialysis at certain Medicare-certified hospitals and Medicare-certified end stage renal disease (ESRD) facilities. AHCCCS pays for all medically necessary services, supplies, and testing (including regular laboratory testing).

Podiatry Services
Podiatry services are covered for adults 21 years of age and older when ordered by the member’s
primary care provider and services are provided by a licensed podiatrist.

Rehabilitative Services
AHCCCS pays for physical, occupational, speech, and respiratory (breathing) therapy services as well as audiology (hearing testing). This must be:

Ordered by a provider, and
Provided by (or under the direct supervision of) a licensed therapist.

Occupational therapy and physical therapy sessions are limited to 30 sessions each per therapy type, per benefit year.

Limitations:
Outpatient speech therapy services are only covered for children under 21 years of age, and
AHCCCS does not pay for physical therapy if no improvement is expected.

Vision Services
AIHP covers eye care services provided by AHCCCS registered eye care professionals (ophthalmologists and optometrists). There are limits based on the member’s age and eligibility:

Vision Services for children under 21 years of age:
Routine eye exams and eyeglasses are covered, and
Eyeglass replacement and repair.

Vision Services for adults 21 years of age and over:
Treatment of medical conditions of the eye are covered,
Routine eye examinations for prescription lenses are not covered, and
Eyeglasses may be considered medically necessary for adults following cataract surgery.

Transportation for Medical & Behavioral Health Appointments
Non-Emergency Medical Transportation (NEMT)
AHCCCS covers non-emergency medical transportation (NEMT) to and from medically necessary medical and behavioral health covered services. This service is available for members who are unable to provide or pay for their own transportation, when free transportation services are not available.

AHCCCS covers NEMT to the nearest IHS/ 638 medical or behavioral health facility or to the
nearest medical or behavioral health provider capable of meeting your needs.

Your health care provider may need to obtain approval (prior authorization) from AHCCCS before the transport occurs.

Transportation from a Hospital to another Facility
Round-trip ground ambulance transportation may be covered if you are hospitalized and need to be taken to the nearest appropriate facility for special services if:

Use of any other type of transportation may be unsafe, or
You cannot get the services needed at the hospital where you are staying.

Behavioral Health Services
AHCCCS covers behavioral health services provided at IHS/638 facilities, or at an AHCCCS registered provider who accepts Fee-for-Service. AHCCCS pays for mental health, substance (drug and alcohol) use treatment, and crisis services. You do not need a referral from your doctor for behavioral health services.

All AHCCCS members have access to behavioral health services, including:
Persons designated with a serious mental illness (SMI), and
Members who are eligible to receive services funded through federal block grants.

A member designated with a Serious Mental Illness (SMI) is a person 18 years or older with a mental, behavioral, or emotional disorder that severely and negatively affects their daily life. The member may not be able to remain in the community without treatment and/or services. A referral or request can be coordinated with the member’s behavioral health provider or TRBHA to assess and determine if a member is eligible to receive SMI services. AIHP members designated with an SMI, may receive assistance with coordination of behavioral health services through either a TRBHA and/or an AHCCCS registered provider.
AHCCCS covers:
Inpatient services in a hospital and other facilities,
Partial care (supervised, treatment or medical day programs),
Individual, group, and/or family counseling and therapy,
Emergency/crisis services,
Behavior management (behavioral health personal assistance, family, and peer support),
Evaluation and diagnosis,
Medicine and monitoring of medicine,
Psychosocial rehabilitation (living skills training, health promotion, pre-job training, education and development, job coaching, and employment support),
Laboratory and radiology services,
Screening,
Emergency transportation,
Non-emergency transportation, and
Respite care (with limits).

Crisis services are available to any Arizona resident, regardless of health insurance coverage. If you or someone you know is experiencing a behavioral health crisis, please call one of these national or local crisis lines:

Medicines
AHCCCS covers medicines prescribed by your provider. There are three places you can go to get your medicines:

IHS facilities,
Tribal 638 facilities, or
Pharmacies that are part of Optum Rx’s network.
AIHP FFS Pharmacy Network 

Please work with your physician, dentist, or other health care provider to get your prescriptions through the appropriate pharmacy. It is best to have your prescriptions filled at the same pharmacy each time. AHCCCS uses a list of preferred medicines. If your provider prescribes a medicine that is not on the preferred list, the pharmacy will work with your provider to change to a preferred medicine. If your provider disagrees with the change, your provider may need to request prior authorization for the non-preferred medicine in order for AHCCCS to pay for it.

Medicines filled outside of an IHS/638 pharmacy will have their scripts filled through Optum Rx,
AHCCCS’ Pharmacy Benefit Manager (PBM).
If you have questions about your prescription benefits, please call 1-855-577-6310. You can get information about your prescription benefits 24 hours a day every day of the week. You may also visit our website at:

AHCCCS Prescription Resource Site

Tribal ALTCS - Arizona Long Term Care Services
The Arizona Long Term Care System (ALTCS) provides culturally competent care for disabled and elderly American Indians who are living on-reservation or who have lived on a reservation prior to admission into a nursing facility located outside of the reservation. ALTCS provides institutional care and home and community-based services to AHCCCS members who are at risk of institutionalization. A complete list of covered services can be found in the ALTCS member handbook.

Members may receive ALTCS services through the Department of Economic Security, Division of Developmental Disabilities (DES/DDD) who is the statewide ALTCS program contractor for persons with developmental disabilities.

American Indians can choose the DDD Tribal Health Program (DDD THP) to receive their physical health services, behavioral health services and Children's Rehabilitative Services (if eligible) from any AHCCCS authorized fee for service provider statewide.

Advance Directives
There may be a time when you are unable to make medical decisions for yourself. An Advance Directive is a legal document that you sign to protect your right to refuse any health care that you do not want, and to receive any health care you do want.

The following are different types of Advance Directives:

A living will tells providers what types of services you do or do not want if you become sick,
A medical power of attorney lets you choose a person to make decisions about your health care when you cannot do it yourself, and
A pre-hospital medical care directive tells providers if you do not want certain lifesaving emergency care that you would get outside a hospital or in a hospital emergency room.

Other Insurance
Please be sure to tell your health care provider about all medical insurance that you have. Other insurance may pay for some or all of your medical care. This may affect what AHCCCS can pay for. If there are any changes to your medical insurance, please submit a change report via Health- e-Arizona Plus (HEAplus).

Fraud and Abuse
Fraud or abuse of any type is not allowed. If you suspect fraud or abuse, please contact the AHCCCS Office of Inspector General at 602-417-4193.

Fraud is when a person lies or misleads on purpose in order to receive benefits or services for themselves or another person that would not otherwise be covered.

Abuse means actions that result in unnecessary cost to AHCCCS. Examples of fraud and abuse are:

Giving someone else your AHCCCS ID card so that they can get health care services, or
Using someone else’s ID card to get services, or
Providing incorrect household composition information, or
Hiding employment or self-employment information, or
Misrepresenting medical condition/s or ethnicities.
For questions regarding your AHCCCS membership and covered healthcare services, visit AHCCCS online at https://www.azahcccs.gov/ or contact AHCCCS Division of Member and Provider Services (DMPS).

AHCCCS Member Services

1-800-654-8713

AHCCCS Member FAQs

In Maricopa County, call

602-417-4000

Notice of Non-Discrimination
AHCCCS complies with applicable Federal civil rights laws, does not discriminate, and does not treat people differently on the basis of race, color, national origin, age, disability, or sex.

If you believe that AHCCCS, or an AHCCCS-registered contractor or provider, failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the AHCCCS Office of Administrative Legal Services.

You can file a grievance in person or by mail, fax, or email. Your grievance must be in writing and must be submitted within 180 days of the date that the person filing the grievance becomes aware of what is believed to be discrimination.

Submit your grievance to:

General Counsel, AHCCCS Administration Office of the General Counsel, MD 6200
801 E. Jefferson
Phoenix, AZ 85034
Fax: 602-253-9115
Email: EqualAccess@azahcccs.gov.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at: Complaint Portal Assistant
.

Or by mail at:
U.S. Department of Health and Human Services 200 Independence Avenue, SW
Room 509F, HHH Building Washington, D.C. 20201

Or by phone at:
1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at: Filing With OCR.

Community Resources

AHCCCS Office of Individual and Family Affairs (OIFA)
OIFA’s mission has been to ensure the voices of those who receive behavioral health services, and their families are heard at every level of Arizona’s public behavioral health system
OIFA@azahcccs.gov www.azahcccs.gov/AHCCCS/HealthcareAdvocacy/OIFA.html

Arizona 2-1-1
Community Information and Referral is a call center that can help you find many community services. Example of services:
Food banks ● Clothes ● Shelters ● Assistance to pay rent and utilities ● Education programs Dial 2-1-1 877-211-8661
Arizona Relay, callers: 7-1-1 https://211arizona.org/
ARIZONA@WORK
provides comprehensive statewide and locally based workforce solutions for job seekers and employers. https://arizonaatwork.com/

Arizona Department of Health Services 150 N. 18th Ave. Phoenix, AZ 85007 602-542-1025
https://www.azdhs.gov/
24 Hour Breastfeeding Hotline: 1-800-833-4642

Arizona Department of Health Services –
Bureau of Women and Children’s Health Office for Children with Special Health Care Needs (OCSHCN) 602-542-1025 OCSHCN@azdhs.gov
https://www.azdhs.gov/prevention/womens-childrens-health/ocshcn/index.php

Arizona Early Intervention Program (AzEIP)
Helps families of children with disabilities or developmental delays age birth to three years old. 1789 W. Jefferson St., Fl4NW
Phoenix, AZ 85007-3202

602-532-9960 or 1-844-770-9500 (Option 5)
Referrals: 1-888-592-0140 https://des.az.gov/services/disabilities/developmental-infant

Opioid Assistance and Referral Line
Confidential advice and services available 24 hours a day, 7 days a week. Staffed by certified nurses and pharmacists.
1-888-688-4222

AZLINKS
AzLinks.gov offers assistance and information on aging and disability.
Use AzLinks.gov to plan for the future or handle an immediate need for seniors, people with disabilities, caregivers, friends and family members, and professionals assisting others.
602-542-4446
www.AzLinks.gov

Dump the Drugs AZ
Use this tool to find a convenient disposal location for Unneeded or expired prescriptions left in the home. https://azdhs.gov/gis/dump-the-drugs-az/

Low Income Housing Services
The Housing authority of Maricopa County improves the quality of life of families and strengthen communities by developing and sustaining affordable housing programs
Maricopa Housing Authority
8910 N. 78th Ave., Building D Peoria, AZ 85345 602-744-4500 https://maricopahousing.org/

Vocational Rehabilitation
The Vocational Rehabilitation program provides a variety of services to persons with disabilities, with the ultimate goal to prepare for, enter into, or retain employment.
https://des.az.gov/vr

Family-Run Organizations Providing Children’s Services
Family-run organizations employ parents who have real life experience in the behavioral, medical and/or Department of Child Safety (DCS) systems. They specialize in providing family support services and can provide one-on-one support to you. https://www.azahcccs.gov/AHCCCS/Downloads/FamilyRunOrganizationsFlyer.pdf

Peer-Run Organizations
Peer-run organizations are service providers owned, operated and administrated by persons with lived experiences of mental health and/ or substance use disorders. These organizations are based in the community and provide support services. https://www.azahcccs.gov/AHCCCS/Downloads/PeerRunOrganizationsFlyer.pdf

Women, Infants, and Children (WIC)
The Arizona Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition education and breastfeeding support services, supplemental nutritious foods and referrals to health and social services. WIC serves pregnant, breastfeeding, and postpartum women; infants; and children under the age of five.
(800) 252-5942
https://www.azdhs.gov/prevention/azwic/
StrongHearts Native Helpline
is a 24/7 confidential and anonymous culturally appropriate domestic and sexual violence helpline for Native Americans.
1-844-762-8483
https://strongheartshelpline.org/

National Domestic Violence Hotline
1-800-799-SAFE (7233)
https://www.thehotline.org/

Office of Human Rights
Provides advocacy to individuals with a Serious Mental Illness (SMI) to help them understand, protect and exercise their rights, facilitate self-advocacy through education and obtain access to behavioral health services in the public behavioral health system in Arizona
Phoenix: 1-800-421-2124 Flagstaff: 1-877-744-2250 Tucson: 1-877-524-6882
https://azahcccs.gov/AHCCCS/HealthcareAdvocacy/ohr.html