Copayment information from 10/1/2010 to 12/31/2013
As a result of changes in Federal and State laws and regulations, including provisions of the Deficit Reduction Act of 2005, AHCCCS will expand member copayment requirements effective October 1, 2010. The expanded copayment requirements, which are described in AHCCCS Final Rule A.A.C. R9-22-711, include mandatory copayments for certain populations, higher optional copayment amounts for certain populations, and clarification of the services and populations which are exempt from both mandatory and optional copayments. The expanded copayment requirements will result in cost savings to the State.
Mandatory Copayments:
AHCCCS members who will have mandatory copayments for certain services beginning October 1, 2010 are:
- Transitional Medical Assistance (TMA) members
- Childless Adults (also known as AHCCCS Care)
- MED (Medical Expense Deduction) members
("Childless Adults" and MED members are also referred to collectively as the "AHCCCS Expansion Population" or the "TWG (Title XIX Waiver Group) Population.")
Mandatory copayments permit providers to deny services to members who do not pay the copayment. However, certain services (such as emergency services) are exempt from mandatory copayments, and specific members (such as individuals under the age of 19) are also exempt from copayments.
Optional Copayments (also known as "nominal"):
Optional copayments apply to AHCCCS members who are not required to make the mandatory copayments as noted above. When a member has an optional copayment, providers are prohibited from denying the service when the member is unable to pay the copayment. As with mandatory copayments, there are certain services (such as emergency services) and certain populations (such as individuals under age 19) which are exempt from the optional copayment. The optional copayment amounts have been updated to reflect slightly higher amounts beginning October 1, 2010.
Regulatory Updates
Proposed changes to the State Plan and Arizona Administrative Code are posted here.
- Medicaid State Plan Amendments (SPAs)
- Final Rules filed with AZ Secretary of State
Information for Members
Members should contact their health plans for additional information about their cost sharing requirements.
Additional questions can be e-mailed to AHCCCSCoPays@azahcccs.gov
