The 1115 Waiver refers to section 1115 of the Social Security Act (SSA). States must comply with Title XIX (Medicaid) and Title XXI (Children's Health Insurance Program) of the SSA. Since Arizona began providing Medicaid on October 1, 1982, AHCCCS has been exempt from specific provisions of the SSA, pursuant to an 1115 Research and Demonstration Waiver. Arizona's 1115 Waiver includes the following: Provisions in the SSA and corresponding regulations AHCCCS is exempt from; Special Terms and Conditions (STCs) that AHCCCS must fulfill; and Approved federal budget amounts.
On 10/14/22, CMS approved Arizona’s request for a five-year extension of its 1115 Waiver, continuing the long-standing authorities and programs that have made Arizona’s Medicaid program innovative, effective, and efficient, including integrated managed care for AHCCCS populations through AHCCCS Complete Care (ACC); the Arizona Long Term Care System (ALTCS); the Comprehensive Health Plan (CHP) for children in foster care; and Regional Behavioral Health Agreements (RBHAs) which provide integrated care for individuals with a Serious Mental Illness (SMI). In addition to renewing these historic programs, this 1115 Waiver includes approval for transformative projects intended to advance member health outcomes, Targeted Investments 2.O and Housing and Health Opportunities. In addition, the Waiver removed a prior limit on adult dental services for American Indian/Alaska Natives served by IHS and Tribal 638 facilities.
On 10/14/22, CMS approved Arizona’s request for a five-year extension of its 1115 Waiver, continuing the long-standing authorities and programs that have made Arizona’s Medicaid program innovative, effective, and efficient. In addition to renewing the historic programs, this 1115 Waiver includes approval for transformative projects intended to advance member health outcomes. More information on 1115 Waiver deliverables can be found below.
On 10/14/22, CMS approved Arizona’s request for a five-year extension of its 1115 Waiver, continuing the long-standing authorities and programs that have made Arizona’s Medicaid program innovative, effective, and efficient. In addition to renewing the historic programs, this 1115 Waiver includes approval for transformative projects intended to advance member health outcomes. More information including the approved package can be found below.
On September 30, 2016, CMS approved Arizona’s request to modernize its Medicaid program and continue many of the existing authorities that allows AHCCCS to maintain its unique and successful managed care model, use home and community based services for members with long term care needs and other innovations that make AHCCCS one of the most cost effective Medicaid programs in the nation. More information including the approved package can be found below. On Sept. 30, 2021, CMS granted a one-year extension to the existing 1115 Waiver
On September 30, 2015, CMS approved Arizona’s 1115 Waiver amendment to the DSH payment methodology to modify payment pool qualification and priority for DSH program year ending 2015. More information is provided in the links below.
On June 18, 2015, CMS approved Arizona’s 1115 Waiver technical amendment to update the DSH methodology to reflect the 2015 DSH amounts. More information is provided in the links below.
On December 15, 2014, CMS approved Arizona’s 1115 Waiver amendment request that will:
More information, including the provisions of all of Arizona's Waiver and Expenditure Authorities and accompanying Special Terms and Conditions can be found in the links below.
Additional background regarding the waiver amendments can be found below.
AHCCCS is proposing to reimburse for the full array of services available to eligible Medicaid beneficiaries under the State Plan and 1115 waiver provided to pregnant women who are eligible under the Hospital Presumptive Eligibility program.
AHCCCS is proposing to expand integrated health care service delivery by allowing the Greater Arizona RBHAs to provide physical and behavioral health care services to individuals with Serious Mental Illness in order to maximize care coordination statewide.
This amendment request seeks an additional one year extension to allow payments to PCH under SNCP and to I.H.S. and 638 facilities under the uncompensated care payment authority to continue through December 31, 2015.
One of the largest 638 facilities, Tuba City Regional Health Care Corporation located on Navajo Nation, has recently had to absorb the cost of care for the population incarcerated within the Navajo Detention Facility at Tuba City, even though these patients are federal trustees for whom the facility would otherwise be receiving reimbursement from Medicaid. Lack of availability of Medicaid funding for the care provided to these inmates is proving unsustainable for the Tuba City Regional Health Care Corporation, one of the most critical providers of care to the American Indian Medicaid enrolled population in Arizona. AHCCCS is proposing to preserve access to care for a critical Medicaid population that is largely American Indian living in rural and frontier areas; and collect data to establish a line item within the Indian Health Services budget as more of these facilities are built on reservation. AHCCCS is accepting public comments on this DRAFT proposal through June 27, 2014. See the Public Comment section below for instructions on how to send comments on this proposal.
At the direction of the Arizona State Legislature and upon CMS approval, AHCCCS is proposing to impose mandatory cost sharing on the Expansion Population of:
On June 27, 2014, CMS approved Arizona’s 1115 Waiver technical amendment to update the DSH methodology to reflect the 2014 DSH amounts. More information is provided in the links below.
April 17 2013
On April 17, 2013, CMS approved Arizona’s 1115 Waiver amendment request that will
allow AHCCCS to match provider assessment monies collected by the City of Phoenix.
These funds will be used to support:
More information, including the provisions of all of Arizona's Waiver and Expenditure Authorities and accompanying Special Terms and Conditions can be found in the links below. Additional background regarding this amendment is available on the "Waiver History" tab at the top of this page.
CMS City of Phoenix Tax Approval Letter 4/16/13January 31, 2013
On January 31, 2013, CMS approved Arizona’s requests to:
More information, including the provisions of all of Arizona's Waiver and Expenditure Authorities and accompanying Special Terms and Conditions can be found in the links below. Additional background regarding these amendments is available on the "Waiver History" tab at the top of this page.
CMS Approval Letter 4/8/13January 31, 2013
AHCCCS received federal approval to integrate physical and behavioral health services
provided to children enrolled in the CRS program. The links below have additional
information:
CMS approval
letter 1/31/13
CRS
Proposal to CMS 4-18-12
January 31, 2013
AHCCCS received federal approval to integrate physical and behavioral health services
provided to adults residing in Maricopa County who are diagnosed with a serious
mental illness. The links below have additional information:
CMS approval
letter 1/31/13
ADHS/DBHS Website
2013 RFP Timeline(Tentative)
Proposal to CMS
Fact Sheet New Maricopa
County RBHA
November 2, 2012
As part of its most recent legislative session, the Arizona legislature passed HB2526,
establishing a tax on the nursing facilities within the State beginning October
1, 2012. The assessment would neither be uniform nor broad-based; therefore the
State is seeking a waiver of the broad-based and uniformity requirements. Below
are links to the waiver proposal to and approval from CMS.
Proposal to CMS
CMS Approval
Letter
August 8, 2012
In late August, AHCCCS will be making $35 million in payments to hospitals for Emergency
Department and Trauma facilities. AHCCCS was able to secure flexibility from CMS
to draw in additional funding for hospitals statewide. Trauma centers will receive
$23.2 million, Emergency Departments will receive $6.2 million and rural hospitals
will receive an additional $5.5 million.
July 30, 2012
On July 30, 2012, CMS approved updates to Arizona’s
Disproportionate Share Funding as Exhibit 3 to
Attachment D of Arizona's 1115 Waiver.
DSH Approval
Letter
Special Terms
and Conditions
June 21, 2012
On June 21, 2012, CMS approved the Safety Net Care Pool (SNCP) Protocol as Attachment
I of Arizona's 1115 Waiver. The protocol provides for the computation of the uncompensated
care cost limit for each provider type that is authorized to receive uncompensated
care payments under the SNCP program.
SNCP
Approval Letter
April 6, 2012
On April 6, 2012, CMS approved the Safety Net Care Pool program to provide hospitals
with funding to cover their costs of providing uncompensated care.
SNCP Fact Sheet
CMS Approval
Letter 04/06/12
Waiver and Expenditure
Authorities
Special
Terms and Conditions
November 28, 2011
Governor Brewer and area hospitals propose to use local dollars to fund uncompensated
care and hospital improvements. The proposal is pending before CMS.
SNCP Revised Proposal
11/14/11
SNCP Original Proposal 7/29/11
Status Update
[1.09MB] (See item #15)
April 6, 2012
Along with the approval of the SNCP program, CMS approved a portion of the SNCP
funding to provide coverage to a limited number of children. More information
about the KidsCare II program is available on the link below:
KidsCare II Program
April 6, 2012
On April 6, 2012, CMS granted AHCCCS with authority to make supplemental payments
to IHS and tribal 638 facilities to address the fiscal burden of uncompensated care
for services provided by such facilities.
SNCP Fact
Sheet
CMS Approval
Letter 04/06/12
Waiver and Expenditure
Authorities
Special
Terms and Conditions
October 25, 2010
AHCCCS has been working with CMS to obtain federal approval to exempt services received
at Indian Health Services (IHS) and 638 facilities paid at 100% federal match from
recent benefit and eligibility reductions.
CMS Letter update 2/17/12
CMS Letter
– 12/16/10
AHCCCS Letter
– 10/25/10
Benefits Page
Thur Feb 15, 2012
CMS denied the Copper Queen Community Hospital (CQCH) proposal to use donated funds
from private hospitals to draw federal matching dollars for uncompensated care programs
at such hospitals. However, AHCCCS continues to work with CMS on other hospital
funding proposals such as the Safety Net Care Pool (SNCP), which includes using
state gaming monies associated with Proposition 202 to draw federal matching dollars.
More information about the CQCH and SNCP proposals is provided in the links below.
Provider Donation Proposal
8/19/11
CMS Denial Letter 2/10/12
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.
Thur Jul 7, 2011
Effective October 1, 2011, AHCCCS will no longer cover Medicare Part B Premiums
for approximately 10,000 ALTCS members.
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.
Fri December 09, 2011
As part of Arizona’s Medicaid Reform Plan and in an effort to increase member accountability
and provider satisfaction during a period of decreased funding in Arizona’s Medicaid
program, effective January 1, 2012, healthcare providers will be able to impose
a fee to Adults Eligible for AHCCCS for Families with Children under Section 1931
of the Social Security Act and individuals eligible for AHCCCS Care (childless adults)
who reside outside of Maricopa and Pima counties for missed appointments if certain
conditions are met. This authority expires December 31, 2012.
Fri Oct 21, 2011
On October 21, 2011, CMS approved Arizona’s Section 1115 Research and Demonstration
Waiver for a period to begin October 22, 2011 through September 30, 2016. More information,
including the provisions of the Waiver and accompanying Special Terms and Conditions
are provided below:
Waiver Approval Fact Sheet
CMS Approval Letter
Waiver Approval Package
Thurs Oct 13, 2011
Arizona's current 1115 Waiver authority
was previously extended until October
14, 2011. The Waiver will be further
extended to provide CMS with additional
time to finalize the approval process.
All current authorities and terms of the
existing 1115 Waiver will be in place
until the new 1115 Waiver is approved by
CMS. AHCCCS will continue to work with
CMS to transition to the new 1115 Waiver
Demonstration.
Fri Oct 7, 2011
On October 7, 2011, CMS sent AHCCCS a letter summarizing the status of the Waiver
negotiations and outlining the various proposals in the Governor's Medicaid
Reform Plan. This letter should only serve as an update on CMS's review of the
authorities requested and should not be interpreted as a formal approval or disapproval
of the final Waiver agreement.
Fri Sept 30, 2011
Arizona's current 1115 Waiver authority
will be extended until October 14,
2011. All current authorities and terms
of the existing 1115 Waiver will be in
place until the new 1115 Waiver is
approved by CMS. AHCCCS will continue
to work with CMS to transition to the
new 1115 Waiver Demonstration.
Childless Adult Phase Out Plan
Pursuant to the flexibilities outlined in Secretary Sebelius’ letter, Governor Brewer’s Medicaid Reform Package includes a freeze on the childless adult population. A Phase Out Plan was submitted to CMS on April 11, 2011 and the final plan was approved by CMS on July 1, 2011. AHCCCS eligibility systems will stop screening for the Childless Adult eligibility category beginning July 8, 2011.
Phase Out Plans to CMS
Prop. 204 Litigation
On March 31, 2011, AHCCCS submitted a revised Waiver Demonstration proposal to CMS incorporating provisions of the Governor's Medicaid Reform Plan. Waivers from various federal requirements are needed for flexibilities that will allow the State to manage its Medicaid program within budgetary constraints. AHCCCS is seeking public comment on the Revised Waiver Proposal. More information is provided below, including a link to submit comments
Pursuant to the flexibilities outlined in Secretary Sebelius’ letter, Governor Brewer’s Medicaid Reform Package includes the phase out of the MED program. A phase out plan was submitted to CMS on March 16, 2011. This MED phase out plan must be approved by CMS prior to implementation. AHCCCS is seeking public comment on the MED Phase Out Plan. More information is provided below, including a link to submit comments.
The New Waiver Request will alsoinclude a request from the Maintenance of Effort (MOE) requirements of the Affordable Care Act. The AHCCCS MOE waiver was submitted to the Secretary on January 25, 2011. More information will be posted to the web as it becomes available. Continue to visit this page for updates on its progress.
Arizona's current waiver is scheduled to expire on September 30, 2011. Information about how the Waiver allows Arizona to run its efficient and innovative program as well as next steps is provided below.
Note: Information provided in PDF files.
Secretary Sebelius’ Letter to Governor Brewer 2/15/11
Arizona's previous versions of its Section 1115 Waiver are available below:
Fri Oct 21, 2011
On October 21, 2011, CMS approved Arizona’s Section 1115 Research and Demonstration
Waiver proposal for a period to begin October 22, 2011 through September 30, 2016.
More information, including the provisions of the Waiver and accompanying Special
Terms and Conditions are provided below:
Waiver Approval Fact Sheet
CMS Approval Letter
Waiver Approval Package
AHCCCS 2012-2016
Budget Neutrality 10/2011
2006-2011 Waiver Arizona Medicaid Section 1115 Demonstration Project Waiver
