Support for AHCCCS Members Who Become Incarcerated: Enrollment Suspension/Reinstatement
Federal law prohibits states from using Medicaid funding to pay for health care services for individuals who are incarcerated. Historically, state Medicaid agencies terminated benefits when members became incarcerated. This approach caused interruptions to coverage periods extending beyond the incarceration dates as it required a new application and processing time for the approval. During service interruption periods, state and local governments would then absorb the financial responsibility for uncompensated health care services to uninsured individuals.
In an effort to reduce the number of uninsured Arizonans and reduce disruptions to care for members who become incarcerated, AHCCCS launched an innovative Enrollment Suspense initiative in 2017 which utilizes electronic data sharing agreements with Arizona prisons, jails, and detention facilities to allow Medicaid benefits to remain unaffected by incarceration in most cases. Rather than terminating Medicaid benefits upon incarceration, AHCCCS temporarily suspends the member’s health plan enrollment to a “no pay” status for the duration of the incarceration period. Through this initiative, Medicaid benefits are maintained and care coordination can be initiated by the assigned AHCCCS health plan prior to the member being released from incarceration. See Justice System Reach-In.
AHCCCS highly encourages all Arizona prisons, jails, and detention facilities to participate in the Enrollment Suspension process and offers technical assistance in implementing electronic data sharing. For additional information about entering an enrollment suspense intergovernmental agreement with AHCCCS, please see Resources for Justice System Stakeholders.