AHCCCS Works Waiver Amendment Request

Senate Bill 1092 was passed during the First Regular Session of 2015. The legislation requires the Arizona Health Care Cost Containment System (AHCCCS) to apply the Centers for Medicare and Medicaid Services (CMS) by March 30 of each year for a waiver or amendments to the current Section 1115 Waiver to allow the State to implement new eligibility requirements for “able-bodied adults”.

Recognizing the direct effects of social and economic factors on health outcomes, the Arizona Health Care Cost Containment System (AHCCCS) has submitted a formal 1115 Waiver Amendment Request on December 19, 2017 to the Centers for Medicare and Medicaid Services (CMS) seeking authority to implement community engagement requirements and a five-year maximum lifetime benefit limit for a portion of the Medicaid population.

This waiver amendment request, titled “AHCCCS Works” is designed to provide low-income, able-bodied adults the tools needed to gain and maintain meaningful employment, job training, and education. Able-bodied adults between the ages of 19 and 55 who do not qualify for an exemption will be required to meet the following activities or combination of activities for at least 20 hours per week to qualify for AHCCCS coverage:

• Be employed or actively seek employment;
• Attend school; or
• Partake in Employment Support and Development program as defined in the waiver request.

Certain individuals are exempted from the AHCCCS Works requirements, including:

• Those who are at least 55 years old;
• American Indians;
• Women up to the end of the month in which the 90th day of post-pregnancy occurs;
• Former Arizona foster youths up to age 26;
• Individuals determined to have a serious mental illness (SMI);
• Individuals currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government;
• Individuals who are determined to be medically frail;
• Full-time high school students who are older than 18 years old;
• Full-time college or graduate students;
• Victims of domestic violence;
• Individuals who are homeless;
• Individuals who have recently been directly impacted by a catastrophic event such as a natural disaster or the death of a family member living in the same household;
• Parents, caretaker relatives, and foster parents; or
• Caregivers of a family member who is enrolled in the Arizona Long Term Care System.

Consistent with requirements in Arizona statute, the initiatives proposed were informed by a robust public input process conducted over several months in early 2017 that included three public forums, an in-person tribal consultation, and over 500 written submissions.

Upon response from CMS, additional information will be posted here.