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CMS Approves Waiver Request to Add Community Engagement Requirement and Change Retroactive Coverage


The Arizona Health Care Cost Containment System (AHCCCS) received 1115 Waiver Amendment approval from the Centers for Medicare and Medicaid Services (CMS) to implement community engagement requirements for some able bodied AHCCCS members ages 19 to 49, and to limit retroactive coverage for some applicants to the beginning of the month in which the Medicaid application is filed.

The community engagement program, called AHCCCS Works, is designed to encourage qualifying members to use existing community services and resources in order to gain and maintain meaningful employment, job training, education, or volunteer service experience.

“This approval from CMS will allow Arizona to implement a community engagement requirement for able-bodied adults on AHCCCS, much like the work requirements that already exist in other state benefit programs. Employment and community engagement are proven to have a positive effect on overall health and well-being. By aligning educational and employment incentives, and providing robust job search support services and educational opportunities, Arizona can create pathways toward better health outcomes and employment opportunities for our citizens,” said Governor Doug Ducey.

The AHCCCS Works community engagement requirements will apply to able-bodied adults ages 19 to 49 who are not eligible for one of the following exemptions: pregnant women up to the 60th day of post-pregnancy; former Arizona foster youths up to age 26; members of a federally recognized tribe; individuals determined to have a serious mental illness (SMI); members with a disability recognized under federal law and individuals receiving long term disability benefits; individuals who are medically frail or who have an acute medical condition; members who are in active treatment for a substance use disorder; full-time high school, college, and trade school students; survivors of domestic violence; individuals who are homeless; a designated caretaker of a child under age 18; a caregiver who is responsible for the care of an individual with a disability; individuals who receive assistance through SNAP, Cash Assistance or Unemployment Insurance or who participate in another AHCCCS-approved work program.

Members who are required to comply with AHCCCS Works will participate in at least 80 hours of community engagement activities per month and report those hours by the 10th day of the following month. Engagement activities include: employment (including self-employment); less than full-time education; job or life skills training; job search activities; and community service. At the program start date, members will have a three-month period in which to become familiar with requirements and tools available to ensure their success. After that three-month period, members who do not complete at least 80 hours of community engagement in a month will be suspended from AHCCCS coverage for a two-month period, followed by automatic reinstatement.

“Congratulations to Governor Ducey and his team for their hard work and unwavering commitment to serving the people of Arizona,” said CMS Administrator Seema Verma. “The approval of the AHCCCS 1115 Waiver, which will strengthen the state’s Medicaid program to deliver value to Arizonans, is a testament to states knowing what’s best for their local communities. The Trump Administration remains committed to supporting state innovation to ensure states have the flexibility needed to provide better health outcomes for their citizens.”

The AHCCCS Works program is scheduled to begin no sooner than January 1, 2020. Approximately 120,000 members will be required to participate. More details will be provided as operational plans are finalized. Members who will be required to participate will receive detailed information about compliance requirements. In order to receive communication from AHCCCS, members are encouraged to update their personal contact information in www.healtheArizonaPlus.gov, the online Medicaid eligibility system, or by calling 1-855-HEA-PLUS (1-855-432-7587).

With this waiver approval, AHCCCS will implement a change no earlier than April 1, 2019 to retroactive coverage for newly eligible Medicaid enrollees. Coverage for new Medicaid enrollees will be retroactive to begin the first day of the month in which the Medicaid application is received. Women who are pregnant (up to 60 days postpartum) and children under age 19 are exempt from this change and may still apply to receive retroactive coverage for the three months prior to the month of application.

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