Many people that are seeking healthcare coverage are applying through the federally-facilitated
Marketplace or insurance exchange – www.healthcare.gov. The Marketplace does
not make AHCCCS eligibility determinations, but it does screen applicants for AHCCCS based on your income. The
Marketplace system will tell people who screen AHCCCS eligible that the State will complete their eligibility
determination soon. Recently, the federal government announced that 11,000 individuals had been assessed as Medicaid
eligible through the Marketplace in Arizona.
The reality is AHCCCS does not have any applications that started from healthcare.gov. Since AHCCCS does not have
those applications, no one has been made AHCCCS eligible if they applied on the Marketplace. The federal government
is not able to transfer applications of individuals that screen eligible for AHCCCS. At this time, the federal
government does not have a date by which they expect this capability to be functioning. So if the Marketplace
screens you as AHCCCS eligible, you must apply for AHCCCS directly. At some future date yet to be determined,
the Marketplace will automatically transfer your application to AHCCCS and you will not need to do anything further.
But for now, that functionality is not available.
The Supreme Court ruling on the Affordable Care Act (ACA) provides states multiple
and complex opportunities with respect to the future of their Medicaid programs.
With these opportunities in mind, Governor Brewer signed into law the AHCCCS Restoration
Plan which restores coverage to thousands of Childless Adults and provides coverage
for those between 100-133% of the Federal Poverty Level, beginning January 1, 2014.
The links below provide detailed information regarding the impact of these provisions
to Arizona’s Medicaid program. Additional information will be posted to this page
as soon as it becomes available.
The AHCCCS Strategic Plan identifies four goals critical to sustain and build on
the success of the AHCCCS program in light of the restoration of coverage -- the
most important healthcare policy issue the State has faced since the inception of
the AHCCCS program 30 years ago and can be found on the link below:
AHCCCS will be involved in a variety of stakeholder efforts to inform and accept
feedback from the public regarding Medicaid Moving Forward. Information will be
posted as soon as it becomes available. Questions and comments can be sent to Forward@azahcccs.gov.
On June 17, 2013, Governor Brewer signed into law her Medicaid Restoration Plan.
Adult coverage will begin January 1, 2014 and applications accepted and processed
beginning October 1, 2013. Applicants are encouraged to use the Health-e-Arizona
Plus online application to apply. The link below provides background information
about how this plan was developed and how it will be funded.
Projected Enrollment 10/1/13-9/31/14
2013 FPL Guidelines
Computer Access, Education and Enrollment Assistance
December 5, 2013
On November 27, 2013, Arizona received federal approval to continue coverage for children above
133% FPL who are enrolled in KidsCare II through January 31, 2014 in order to provide additional
time to transition to the Federally Facilitated Marketplace. Households will receive a notice
informing them about their continued coverage. However, enrollment for KidsCare will remain
frozen in 2014. More information regarding this authority can be
found on the link below:
AHCCCS and DES are leveraging the current Health-e-Arizona system to comply with new requirements for
Medicaid and CHIP eligibility. Health-e-Arizona Plus will be available on or around 10/14/13. In the
meantime, Health-e-Arizona will screen eligibility for childless adults and expansion populations.
Click on the links below for more information.
Medicaid IT Systems
VIDEO: Modernizing Public
VIDEO: New Technology
for Public Assistance Programs
If your organization is interested in becoming a registered community partner to assist
individuals with the online application process for AHCCCS Health Insurance, KidsCare, SNAP
and/or TANF please visit the website below for more information or contact
For further information, please visit the
AHCCCS has received a few inquiries related to incorrect information in the community.
To clarify: HEA IS accepting childless adult (and expansion group) applications. These applications WILL
transfer to HEAplus after the system goes live. You will NOT have to reapply for childless adults or expansion
groups. Childless adults are NOT getting denied today for coverage in January. They may receive a notice letting
them know they are not eligible for coverage from October through December, but the notice also lets them know
we will process their application under the new rules for coverage that would start in January.
October 29, 2013
Notice: Federal online application systems, including Data Service Hubs used by HEAPlus to
confirm identity and other information, continue to experience technical difficulties. The Federal Government continues
to work on improving its systems. If you are unable to complete the online application, please submit your application online
at a later time. AHCCCS will do its best to update you timely once the federal data hub is available but the agency is
dependent on receiving that notice from the federal government
"Go Live" is Saturday, 10/19/13
A decision was made to "go live" with Health-e-Arizona Plus (HEAplus) on Saturday, October 19, 2013.
This date was selected because there is lighter system use on weekends, making it easier to manage the new
system before the heavy work week use starts on Monday.
Before 10/19/13, HEAplus must be updated with application information entered in the current Health-e-Arizona
(HEA) system during the prior 2 week period. This will require that access to HEA be stopped at 7:00 PM on
Thursday, October 17, 2013. HEA will not be available on Friday, October, 18, 2013. We apologize for this inconvenience.
Federally Facilitated Marketplace
On November 18, 2012, Governor Brewer announced that Arizona will participate in
a Federally Facilitated Marketplace (FFM). More information on the Governor’s decision
can be found below. A link to the Marketplace Subsidy Calculator is also included,
which helps estimate premiums and subsidies for people purchasing insurance through
the Marketplace. More information on the FFM can be found at www.healthcare.gov.
Marketplace Decision Letter- 11/28/12
Marketplace and Medicaid Outreach
Find Local Help
For assistance please call 1-800-318-2596
Essential Health Benefits
Governor Brewer selected the State Employee Benefit- United Healthcare EPO with
pediatric, dental and vision coverage supplemented by the FED-VIP as the baseline
Essential Health Benefits package for Arizona. The Essential Health Benefits package
mandates the minimum services for all commercial policies in Arizona. More information
can be found on the links below:
Essential Health Benefits
Governor Brewer Letter 9/28/12
Although Arizona is no longer accepting public comments regarding the Essential
Health Benefits Benchmark Plan, a link to the Essential Health Benefits Report can
be found below. Comments were originally submitted electronically to:
Benchmark Plan Report
CMS has released information regarding the ACA’s provisions and can be found on
the links below. Further discussion with CMS will continue and the information posted
as soon as it becomes available. More information can be found at www.CMS.gov.
Comments on Proposed Rules
State Plan Amendments
Arizona Transition Plan
Medicaid & Medicare Fraud
Although there are a number of changes associated with the Affordable Care Act, changes to Medicare is
NOT one of them. Medicare beneficiaries do NOT need to buy insurance in the new Health Insurance Marketplace.
Unfortunately, there have been a number of reports on fraud-related activity. Arizonans who have Medicare
should use caution and should not share their personal identifying information with anyone. You can report
suspect activity to the Arizona Attorney General’s Fraud Unit below:
1275 W. Washington St.
Phoenix, Arizona 85007
AZ Attorney General Fraud Warning