Arizona Section 1115 Demonstration Project Waiver

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.


What is in the 1115 Waiver

Arizona's 1115 Waiver includes the following:

  • Provisions in the SSA and corresponding regulations AHCCCS is exempt from
  • Terms and conditions that AHCCCS must fulfill
  • Approved federal budget amounts

Pending Waivers

AHCCCS continues to work with CMS on various pending waiver requests. Continue to check the website for updates as developments occur.

  1. Pregnant Women and Hospital Presumptive Eligibility (HPE)

    Currently, federal regulation limits services available to pregnant women under HPE to ambulatory prenatal care. 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.


  2. Phoenix Children’s Hospital SNCP Extension and Uncompensated Care Payments to I.H.S. and 638s Extension

    August 29, 2014

    On December 27, 2013, CMS approved Arizona’s 1115 Waiver amendment request that will allow AHCCCS to use SNCP funding for Phoenix Children’s Hospital and continue uncompensated care payments to I.H.S. and 638 facilities, through December 31, 2014. This amendment request seeks an additional one year extension for both programs, allowing 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.


  3. Tuba City Regional Health Care Corporation

    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.


  4. Cost Sharing
    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:
    • A premium of not more than two percent of the person's household income.
    • A copayment of two hundred dollars for nonemergency use of an emergency room if the person is not admitted to the hospital.
    • A copayment of two hundred dollars for nonemergency use of an emergency room if there is a community health center, rural health center or urgent care center within twenty miles of the hospital.
    AHCCCS is accepting public comments through March 14, 2014 on the proposal found on the link below:
    Cost Sharing Proposal DRAFT 2/11/14 [PDF]
  5. Behavioral Health Integration
    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. AHCCCS is accepting public comments through March 24, 2014 on the proposal at the link below. See the Public Comment section below for instructions on how to send comments on this proposal.
    Greater AZ RBHA DRAFT 2/20/14 [PDF]
    RFI for Greater AZ [PDF]
  6. Medical Homes at I.H.S. and 638 facilities
    AHCCCS is requesting authority to support a Medical Home Program for the FFS population receiving services at Indian Health Service and 638 facilities. More information is included in the proposal below. The REVISED proposal has a 30 day comment period and closes May 15, 2014.

    REVISED Proposal to CMS 4-15-14 [PDF]

    Medical Home Proposal to CMS 8-11-11 [PDF]


Public Comment

AHCCCS is accepting comments regarding the requests and can be submitted in any of the following ways:

PublicInput@azahcccs.gov

AHCCCS
Attn: Office of Intergovernmental Relations
801 E. Jefferson St., MD 4200
Phoenix, AZ 85034


 

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