103 Who Administers AHCCCS Medical Assistance?

 

 

 

Revised 09/14/2021

Policy

AHCCCS Administration works with several agencies in the State of Arizona. Together, we provide services and assistance in the eligibility process to customers. The following agencies work with AHCCCS Administration to coordinate and determine eligibility:

·        The Department of Economic Security (DES);

·        The Department of Child Safety; and

·        The Social Security Administration (SSA).

NOTE     The following sections describe specific programs administered by these agencies, but does not provide a full list of each agency’s responsibilities.

 

1) AHCCCS Administration

AHCCCS Administration responsibilities include:

·        Oversight of the AHCCCS health care system;

·        Administering some health insurance programs;

·        Monitoring and coordinating other agencies, which are responsible for determining eligibility for AHCCCS Medical Assistance programs;

·        Contracting with health plan networks and providers;

·        Monitoring the quality of care provided by participating health care providers; and

·        Maintaining the state’s database of eligible members.

 

2) Department of Economic Security (DES)

There are several divisions within DES that participate with AHCCCS programs. The table below describes the main functions of each division:

Administration

Function

Family Assistance Administration (FAA)

Determines eligibility for:

·        AHCCCS Medical Assistance;

·        Cash assistance;

·        Kinship Foster Care;

·        Tuberculosis Control;

·        Refugee Cash Assistance;

·        Refugee Medical Assistance Programs; and

·        Nutrition Assistance.

Division of Developmental Disability (DDD)

The ALTCS program contractor for all developmentally disabled persons statewide.  DDD is responsible for:

·        Providing a variety of services to persons who have specific disabilities;

·        Making eligibility determinations for DDD services on referrals from ALTCS; and

·        Screening and referring developmentally disabled participants to AHCCCS for an ALTCS eligibility determination.

Disability Determination Services Administration (DDSA)

The Arizona State agency authorized to make disability determinations for the Social Security Administration and AHCCCS.

Mercy Care Department of Child Safety Comprehensive Health Plan (DCS CHP)

Contracts as an AHCCCS Complete Care (ACC) plan to provide medical services to foster children who meet the Title IV-E or Medicaid eligibility criteria.

Division of Child Support Services (DCSS)

DCSS is committed to helping children receive the support they are due.  When a child does not receive financial support from one or both parents, the DCSS helps by:

·        Locating the non-custodial parent;

·        Establishing legal paternity;

·        Establishing a legal support order;

·        Enforcing support orders; and

·        Collecting child support and medical support payments.

 

3) Social Security Administration (SSA)

SSA is responsible for determining eligibility for SSI-Cash benefits. People that qualify for SSI-Cash automatically qualify for AHCCCS Medical Assistance. However, if ALTCS services are needed, they must also be determined medically eligible. The SSA also determines eligibility for Medicare and helps identify persons eligible for the Medicare Savings Program (MSP).

 

4) Department of Child Safety (DCS)

DCS is responsible for:

·        Determining eligibility for foster assistance payments to children in the care and custody of the state;

·        Determining eligibility for Adoption Subsidy payments;

·        Coordinating Medicaid application and eligibility processes; and

·        Providing healthcare coverage to children in state foster care through the Mercy Care Department of Child Safety Comprehensive Health Plan (DCS CHP).

NOTE     Children that qualify for Adoption Subsidy or Title IV-E foster care payments automatically qualify for AHCCCS Medical Assistance.  However, if ALTCS services are needed, they must also be determined medically eligible. 

 

Definitions

Term

Definition

Department of Economic Security (DES)

The state agency responsible for determining AHCCCS Medical Assistance eligibility for:

·        Adults

·        Caretaker Relatives;

·        Pregnant Women;

·        Children;

·        Transitional Medical Assistance; and

·        4-month Continued Coverage.

NOTE     This includes children in the custody of a Tribal Foster Care agency.

Department of Child Safety

The state agency responsible for administering the state’s foster care and adoption subsidy programs.

Social Security Administration (SSA)

The federal agency responsible for determining eligibility for SSI Cash assistance. The SSA also determines eligibility for Medicare.