State Plan for Medicaid
The Medicaid State Plan is a federally mandated contract between the State and the federal government, describing how Arizona’s Medicaid program is administered, and serving as the basis for Federal Financial Participation (FFP). In alignment with established federal regulations, the State Plan covers topics such as Medicaid eligibility standards, provider requirements, payment methods, health benefit packages, and other topics. Changes to the State Plan regularly occur through State Plan Amendments (SPAs), which undergo rigorous negotiations with the Centers for Medicare and Medicaid Services (CMS). Once a SPA is approved, it becomes a permanent part of Arizona’s Medicaid program and is filed in the State Plan.
The State Plan is composed of seven sections:
- Single State Agency and Organization
Identifies the state agency responsible for administering the Medicaid program, and how the agency is organized. - Coverage and Eligibility
Describes who is eligible for Medicaid coverage and the conditions of eligibility. - Services: General Provisions
Describes Medicaid covered services and additional considerations (e.g., the amount, duration and scope of services). - General Program Administration
Describes a variety of topics related to administering the Medicaid program such as payment rates/methods, recordkeeping, quality control, cost sharing, and other topics. - Personnel Administration
Describes standards of personnel administration and topics such as training and subprofessional programs. - Financial Administration
Describes a variety of financial topics including fiscal policies, cost allocation, and state financial participation. - General Provisions
Describes miscellaneous provisions, such as the state plan amendment process, nondiscrimination, and special topics (e.g., Public Health Emergency (PHE) Provisions).
The purpose of this web page is to provide public access to Arizona’s Medicaid State Plan. Below, you will find the complete plan organized into sections and subsections which may be accessed by clicking on the respective links. In addition, you can find a link to the entire plan at the bottom of this web page.
- 1.1: Designation and Authority
- Attachment 1.1-A: Attorney General's Certification
- Attachment 1.1-B: Waivers of the Single State Agency Requirement
- 1.2: Organization for Administration
- Attachment 1.2-A: Agency Organization
- Attachment 1.2-B: Description of the Functions of the Medical Assistance Unit
- Attachment 1.2-C: Professional Medical Personnel and Support Staff
- Attachment 1.2-D: Responsibility for Title XIX Eligibility Determinations
- 1.3: Statewide Operation
- 1.4: State Medicaid Advisory Committee
- 1.5: Pediatric Immunization Program
- 2.1: Application, Determination of Eligibility and Furnishing Medicaid
- Attachment 2.1-A: AHCCCS Prepaid Health Plans
- 2.2: Coverage and Conditions of Eligibility
- Attachment 2.2-A: Groups Covered and Agencies Responsible for Eligibility Determination
- 2.3: Residence
- 2.4: Blindness
- 2.5: Disability
- 2.6: Financial Eligibility
- Attachment 2.6-A: Groups Covered and Agencies Responsible for Eligibility Determination
- 2.6-A Supplement 1: Income Eligibility Levels
- 2.6-A Supplement 2: Resource Levels
- 2.6-A Supplement 3: Reasonable Limits on Amounts
- 2.6-A Supplement 4: Methods for Treatment of Income that Differ From Those of the SSI Program
- 2.6-A Supplement 5: More Restrictive Methods of Treating Resources Than Those of the SSI Program
- 2.6-A Supplement 5a: Methods for Treatment of Resources for Individuals with Incomes Related to Federal Poverty Levels
- 2.6-A Supplement 6: Standards for Optional State Supplementary Payments
- 2.6-A Supplement 7: Income Levels for 1902(f) States
- 2.6-A Supplement 8: Resource Standards for 1902(f) States
- 2.6-A Supplement 8a: More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act
- 2.6-A Supplement 8b: More Liberal Methods of Treating Resources under Section 1902(r)(2) of the Act
- 2.6-A Supplement 8c: State Long-Term Care Insurance Partnership
- 2.6-A Supplement 9: Transfer of Resources
- 2.6-A Supplement 9(a): Transfer of Assets
- 2.6-A Supplement 9(b): Transfer of Assets
- 2.6-A Supplement 10: Consideration of Trusts - Undue Hardship
- 2.6-A Supplement 11: Cost Effectiveness Methodology for COBRA Continuation Beneficiaries
- 2.6-A Supplement 12: Eligibility Under Section 1931 of the Act
- 2.6-A Supplement 12a: Variations from the Basic Personal Needs Allowance
- 2.6-A Supplement 13: Section 1924 Provisions
- 2.6-A Supplement 14: Income and Resource Requirements for Tuberculosis Infected Individuals
- 2.6-A Supplement 16: Asset Verification System
- 2.6-A Supplement 17: Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
- 2.6-A Supplement 18: Methodology for Identification of Applicable FMAP Rates
- 2.7: Medicaid Furnished Out of State
- 3.1: Amount, Duration, and Scope of Services
- Attachment 3.1-A: Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
- Attachment 3.1-A - Limitations
- Supplement to Attachment 3.1-A: Medication-Assisted Treatment (MAT)
- Supplement 1 to Attachment 3.1-A: Case Management Services
- Supplement 2 to Attachment 3.1-A: Home and Community Care
- Attachment 3.1-B: Medically Needy Groups
- Attachment 3.1-C: Standards Established and Methods used to Assure High Quality Care
- Attachment 3.1-D: Methods of Providing Transportation
- Attachment 3.1-E: Standards for Coverage of Organ Transplant Services
- Attachment 3.1-F: Managed Care Delivery System
- 3.2: Coordination of Medicaid with Medicare and Other Insurance
- 3.3: Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
- 3.4: Special Requirements Applicable to Sterilization Procedures
- 3.5: Families Receiving Extended Medicaid Benefits
- 4.1: Methods of Administration
- 4.2: Hearings for Applicants and Recipients
- 4.3: Safeguarding information on Applicants and Recipients
- 4.4: Medicaid Quality Control
- 4.5: Medicaid Agency Fraud Program
- 4.6: Reports
- 4.7: Maintenance of Records
- 4.8: Availability of Agency Program Manuals
- 4.9: Reporting Provider Payments to the Internal Revenue Service
- 4.10: Free Choice of Providers
- 4.11: Relations with Standard-Setting and Survey Agencies
- 4.12: Consultation to Medical Facilities
- 4.13: Required Provider Agreement
- 4.14: Utilization/Quality Control
- 4.15: Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals
- 4.16: Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
- Attachment 4.16-A: Health and Vocational Rehabilitation Agencies and Title V Grantees
- Attachment 4.16-B: Coordination with Special Supplemental Food Program for Women, Infants and Children (WIC)
- 4.17: Liens and Adjustments or Recoveries
- Attachment 4.17-A: Liens and Adjustments or Recoveries
- 4.18: Recipient Cost Sharing and Similar Charges
- Attachment 4.18-A: Cost Sharing
- Attachment 4.18-B: Enrollment Fee and Premiums
- Attachment 4.18-C: Cost Sharing for the Medically Needy
- Attachment 4.18-D: Premiums Imposed on Low Income Pregnant Women and Infants
- Attachment 4.18-E: Optional Sliding Scale Premiums
- Attachment 4.18-F: Alternative Premiums and Cost Sharing Charges
- 4.19: Payment for Services
- Attachment 4.19-A: Methods and Standards for Establishing Payment Rates, Inpatient Hospital Care
- Attachment 4.19-B: Methods and Standards for Establishing Payment Rates, Other Types of Care
- 4.19-B, Supplement 1: Payment of Medicare Part A and Part B Deductible/Coinsurance
- 4.19-B, Supplement 2: Outpatient Differential Adjusted Payment Program
- Attachment 4.19-C: Payment for Reserved Beds
- Attachment 4.19-D: Methods and Standards for Establishing Fee For Service Payment Rates for Long Term Care Facilities
- Attachment 4.19-E: Timely Payment of Claims
- 4.20: Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
- 4.21: Prohibition Against Reassignment of Provider Claims
- 4.22: Third Party Liability
- Attachment 4.22-A: Third Party Liability
- Attachment 4.22-B: Third Party Liability
- Attachment 4.22-C: State Method on Cost Effectiveness of Employer-Based Group Health Plans
- 4.23: Use of Contracts
- 4.24: Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services
- 4.25: Program for Licensing Administrators of Nursing Homes
- 4.26: Drug Utilization Review Program
- 4.27: Disclosure of Survey Information and Provider or Contractor Evaluation
- 4.28: Appeals Process
- 4.29: Conflict of Interest Provisions
- 4.30: Exclusion of Providers and Suspension of Practitioners and Other Individuals
- Attachment 4.30: Sanctions for Psychiatric Hospitals
- 4.31: Disclosure of Information by Providers and Fiscal Agents
- 4.32: Income Eligibility Verification System
- 4.33: Medicaid Eligibility Cards for Homeless Individuals
- Attachment 4.33-A: Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
- 4.34: Systematic Alien Verification for Entitlements
- Attachment 4.34-A: Requirements for Advance Directives Under State Plan for Medical Assistance
- 4.35: Enforcement of Compliance for Nursing Facilities
- Attachment 4.35-A: Enforcement of Compliance for Nursing Facilities
- Attachment 4.35-B: Termination of Provider Agreement
- Attachment 4.35-C: Temporary Management
- Attachment 4.35-D: Denial of Payment for New Admissions
- Attachment 4.35-E: Civil Money Penalty
- Attachment 4.35-F: State Monitoring
- Attachment 4.35-G: Transfer of Residents with Closure of Facility
- Attachment 4.35-H: Additional Remedies
- 4.36: Required Coordination Between the Medicaid and WIC Programs
- 4.38: Nurse Aide Training and Competency Evaluation for Nursing Facilities
- Attachment 4.38: Disclosure of Additional Registry Information
- Attachment 4.38-A: Collection of Additional Registry Information
- 4.39: Preadmission Screening and Annual Resident Review in Nursing Facilities
- Attachment 4.39: Definition of Specialized Services
- Attachment 4.39-A: Categorical Determinations
- 4.40: Survey and Certification Process
- Attachment 4.40-A: Survey and Certification Education Program
- Attachment 4.40-B: Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property
- Attachment 4.40-C: Procedures for Scheduling and Conduct of Standard Surveys
- Attachment 4.40-D: Programs to Measure and Reduce Inconsistency
- Attachment 4.40-E: Process for Investigations of Complaints and Monitoring
- 4.41: Resident Assessment for Nursing Facilities
- 4.42: Employee Education About False Claims Recoveries
- Attachment 4.42-A: Employee Education about False Claims and Recoveries
- 4.43: Cooperation with Medication Integrity Program Efforts
- 4.44: Prohibition on Payments to Entities Located Outside of the United States
- 4.46: Provider Screening and Enrollment
- 7.1: Plan Amendments
- 7.2: Nondiscrimination
- Attachment 7.2-A: Methods of Administration
- 7.4: Medicaid Disaster Relief for COVID-19 National Emergency
- Attachment 7.4-A: Recessions to the State's Disaster Relief Policies for the COVID-19 National Emergency
- 7.4: State Governor’s Review
- 7.7: Time Limited Provisions
- Attachment 7.7-A:COVID-19 Vaccine and Vaccine Administration
- Attachment 7.7-B:COVID-19 Testing
- Attachment 7.7-C:COVID-19 Treatment
- S14: AFDC Income Standards
- S25: Eligibility Groups - Parents and Caretaker Relatives
- S28: Eligibility Groups - Pregnant Women
- S30: Eligibility Groups - Infants and Children
- S32: Eligibility Groups - Adult Group
- S50-S59: Eligibility Groups - Options for Coverage
- S88: Non Financial Eligibility - State Residency
- S89: Non Financial Eligibility - Citizenship and Noncitizen Eligibility
- S94: Eligibility Process
- Eligibility - Mandatory Eligibility Groups (Effective Jan 1 2023)
- Eligibility - Former Foster Care Children (Effective Jan 1 2023)