AHCCCS News & Updates
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Budget Activities pages or the Federal
Coverage of Incontinence Briefs for ALTCS Members
February 10, 2015
On December 15, 2014, the United States Supreme Court refused to hear AHCCCS' appeal of the Court of Appeals decision
in Alvarez v. Betlach which upheld coverage of incontinence briefs for preventive purposes in the lawsuit brought by
several adult ALTCS members. As a result of the Supreme Court action, the court injunction went into effect. Beginning
December 15, 2014, incontinence briefs for ALTCS members age 21 years and older are covered when medically necessary for
preventive purposes. Coverage requirements for this population can be located in
Chapter 300 of the AHCCCS Medical Policy Manual.
Summary of the Executive Proposal to Raise the DSH Hard Caps
The Executive budget increases the disproportionate share hospital (DSH) cap of $89,877,700 for the Maricopa Medical Center which is
managed by the Maricopa Integrated Health System (MIHS) in both State Fiscal Year (SFY) 2015 and SFY 2016. MIHS currently receives a
$4,202,300 DSH payment and the remaining federal portion of MIHS’ DSH allocation is deposited in the General Fund.
Overall Arizona DSH payments are limited to an annual allotment (maximum) established each year by the federal government.
The Arizona budget then allocates this overall allotment into several “pools.” Since Arizona typically uses its entire allotment,
when one pool is increased, another pool(s) must be decreased by a corresponding amount.
Specifically, the Executive budget would increase the MIHS cap to $105,945,500 in SFY 2015 and $113,818,500 in SFY 2016 and lower the
pool 5 allocation by the same amount. Since the federal portion of the DSH payment for MIHS is deposited into the state General Fund,
this would increase the state General Fund deposit by approximately $11 million in SFY 2015 and $16.5 million in SFY 2016.
This would result in a corresponding decrease in pool 5 payments from approximately $32 million in SFY 2015 to approximately
$16 million and from approximately $34 million in SFY 2016 to $10 million. The federal government has not yet finalized the SFY 2015
and SFY 2016 allotments, so SFY 2015 and SFY 2016 amounts may vary slightly.
A document containing the summary and frequently asked questions can be found here.
CMS Announces Round Two State Innovation Model Awards
December 22, 2014
On December 16th, CMS announced grants for the State Innovation Model Initiative, Round 2. Although Arizona
did not receive a Model Test award, it did receive a Model Design award to "create and refine its proposal for
multi-payer and health delivery system transformation." Although Arizona was invited to present in person regarding its proposal,
the State was only awarded a $2.5 million planning grant. This grant is designed to provide the State with funds to engage stakeholders
across all payer types, providers, consumers and others to build a road map for reforming the health care delivery system. Since the
State’s initial proposal was not for a planning grant, the State needs to determine the scope of the planning grant.
Once that is determined, the State will communicate with CMS and begin the stakeholder engagement process. In the alternative, the
State could decline the planning grant funds. More information about the SIM Round 2 awards can be
found on the CMS website:
July 22, 2014
On July 19th, Arizona submitted an application for the CMS State Innovation Model Funding to accelerate the state’s
delivery system transformation towards a value-based integrated model that focuses on whole person health in all settings
and regardless of coverage source. Additional information about the proposed initiative, including the grant proposal
can be found in the link below.
CMS HCBS Rule
November 5, 2014
On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) released final rules regarding
requirements for home and community based services (HCBS) operated under section 1915 of the Social Security
Act. The rules mandate certain requirements for alternative residential or community settings where Medicaid
beneficiaries receive long term care services and supports. While the AHCCCS HCBS program is operated under
section 1115 of the Act and is not subject to those regulations, we anticipate that the federal government will
require compliance with those regulations as part of Arizona’s next renewal of its section 1115 waiver. Because
of that, AHCCCS intends to establish a plan for voluntarily meeting those standards on a time line generally
consistent with the requirements for HCBS programs operated under section 1915. In Arizona, these requirements
impact the residential placements for members enrolled in the Arizona Long Term Care Services (ALTCS) program.
The new rules also impact day programs where ALTCS members receive services during the day only.
AHCCCS is currently in the process of reviewing Arizona’s HCBS settings to determine how it might meet the
new standards that apply to HCBS programs operated under section 1915 of the Act. AHCCCS will publish its
initial assessment of Arizona’s HCBS settings and how they compare with the new rules in the early part of
2015. There will be an opportunity for public comment on the initial assessment. Once public comment is
considered, AHCCCS will submit its assessment to CMS for review. To the extent changes need to be made to
HCBS settings, AHCCCS will work with CMS to establish a Transition Plan. States have 5 years to come into
compliance under the Transition Plan. As part of completing the Transition Plan, AHCCCS will engage
stakeholders and seek public comment.
APPLICATION PROCESS UPDATES
September 11, 2014
Over the summer, AHCCCS dispositioned all of the applications referred from the FFM during the open enrollment period
of October 1, 2014 through March 31, 2014, and we continue to process applications that have been referred since that time.
IMPORTANT: If you are denied AHCCCS coverage for being over income, please apply for health care coverage at
If you apply on HEAplus and your AHCCCS application is denied for being over income, you must go to the Federal Marketplace
to apply for health care coverage. You can do this by going online to www.healthcare.gov,
open an account and complete your application.
Maintenance on Federal Data Sources
March 10, 2014
Federal data sources used by Health-e-Arizona Plus (HEAplus) will not be available during scheduled maintenance times.
When these federal data sources are not available, HEAplus will not be able to accept your application. We apologize for
any inconvenience. Federal data sources will not available during the following times:
- - Monday through Friday, 11:00 pm to 3:00 am, Arizona time.
- - Saturday and Sunday, 9:00 pm to 5:00 am, Arizona time.
Updates regarding AHCCCS enrollment and restoration can be found on the link below. These updates
reflect enrollment as of the first of the month and are typically updated published by the
10th of each month.
AHCCCS Population Report
Medicaid Moving Forward
July 8, 2013
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, the Medicaid Restoration
Plan restores coverage to Childless Adults and provides coverage
for those between 100-133% of the Federal Poverty Level, beginning January 1, 2014.
Medicaid Moving Forward
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