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Information about copayments proposed for members in the new adult group beginning January 1, 2015,
subject to approval by the Centers for Medicare and Medicaid Services can be found at the following
link: Proposed Copay Changes 1/1/15
Some people who get AHCCCS Medicaid benefits are asked to pay copayments for some
of the AHCCCS medical services that they receive.
Some changes to copayments became effective January 1, 2014. These changes to copayments can be found in the new
AHCCCS rule AAC R9-22-711 which started January 2014. For a limited time persons who are eligible in the AHCCCS Care Program
and persons who are determined AHCCCS eligible on and after January 1, 2014 in the new Adult Group will not have any co-payments
starting January 1, 2014. Co-payments for persons in AHCCCS Care and the new adult group are planned for the future. Members will
be told about any changes in copayments before they happen.
Individuals eligible for AHCCCS through any of the following programs are
subject to nominal copayments. The copays apply unless a copay is not charged for the above reasons:
Ask your provider to look up your eligibility to find out what copays you may have. You can also find out by calling your health plan member services representative or by going to
myahcccs.com. You can also check your health plan's website for more information.
Most people who get AHCCCS benefits are asked to pay the following nominal copayments
for medical services:
Medical providers will ask you to pay these amounts but will NOT refuse you services if you
are unable to pay. If you cannot afford your copay, tell your medical provider you are unable to pay these amounts so you will not be refused services.
Families with Children that are no Longer Eligible Due to Earnings - Transitional
Medical Assistance (TMA)
If a family is no longer eligible for any AHCCCS program due to higher income that they get from working,
they may still get AHCCCS benefits through the Transitional Medical Assistance (TMA) program. Adults on
TMA have to pay higher copays for some medical services and will need to pay the copays in order to get the services.
If you are on the TMA Program now or if you become eligible to receive TMA benefits later, the notice from DES or
AHCCCS will tell you so.
Pharmacists and Medical Providers can refuse services if the copayments are not made.
A family receiving TMA will not be required to make the copays if the total amount of the copays made is more than 5% of the gross family income (before taxes and deductions) during a calendar quarter (January through March, April through June, July through September, and October through December.)
When a family receiving TMA benefits thinks that they have paid copays that equal 5% of the family's total quarterly income and AHCCCS has not already told them this has happened, they should send copies of receipts or other proof of how much they have paid to AHCCCS, 801 E. Jefferson, Mail Drop 4600, Phoenix, Arizona 85034.
If you think that your income or circumstances have changed, contact your eligibility office right away.