AHCCCS Whole Person Care Initiative (WPCI)
The AHCCCS Whole Person Care Initiative is focused on improving essential Health-Related Social Needs of enrolled members. Health-Related Social Needs, also known as Social Determinants of Health, have a direct impact on your physical and mental health outcomes. Health-Related Social Needs include things like:
- Homelessness and Housing Instability
- Food Insecurity
- Need for Transportation Assistance
- Employment Instability
- Need for Utility Assistance
- Social Isolation and Social Support
- Interpersonal Safety
- Environmental Safety
- Justice or Legal Involvement
- Education and Childhood Development
- Access to Outdoor Spaces and Parks
Research shows that Health-Related Social Needs contribute to 80% of health outcomes, while only 20% of health outcomes are from direct health care services.
Across the Medicaid delivery system, AHCCCS is working to improve members’ access to resources that can improve their Health-Related Social Needs, and with it, improve health equity in Arizona. Read more about how AHCCCS is addressing health equity.
How AHCCCS Is Addressing Health-Related Social Needs
CommunityCares is a free closed-loop referral system available at no cost for AHCCCS health care providers and community-based organizations. The system allows providers to screen and refer members in order to address Health-Related Social Needs.
Many AHCCCS health care providers are eligible for a Differential Adjusted Payment (DAP) financial incentive for using the system and community-based organizations are eligible for financial incentives as well. Please visit the CommunityCares website for more information.
Health care providers and health plans that are not yet enrolled in CommunityCares will maintain a Community Resource Guide with information on local resources that provide support for Health-Related Social Needs.
Military veterans and their families are eligible to receive services for Health-Related Social Needs through Be Connected, the Statewide Veteran Resource Provider. Learn more about Be Connected.
AHCCCS’ Community Reinvestment Program is another tool that encourages AHCCCS health plans to invest a small percentage of their profits into community projects to improve the Health-Related Social Needs for individuals in the communities they serve. Read more about the AHCCCS’ Community Reinvestment Program.
- AHCCCS Housing Programs
- AHCCCS Health Equity
- AHCCCS Justice Initiatives
- CommunityCares, Arizona’s Statewide Closed-Loop Referral System
- Be Connected – Resources for Veterans and Military Families
- AHCCCS Differential Adjusted Payment (DAP) Program – Incentives for health care Providers
- Department of Economic Security (DES) Office Locator
- For state food and nutrition assistance, utility assistance, unemployment benefits, disability assistance, child and family assistance, adult protective services, domestic and sexual violence support, and refugee resettlement
- Arizona Department of Health Services
- Arizona State Parks
- National Park Service
- AHCCCS Targeted Investments Program
- Using Billing Z Codes for Social Determinants of Health
- Centers for Disease Control and Prevention – Social Determinants of Health
- World Health Organization – Social Determinants of Health
- Arizona Pet Project – Services and Resources for Pets Provided by the State of Arizona
Associated AHCCCS Policies
- ACOM 448 – Housing
- AMPM 310-BB – Transportation
- ACOM 447 – Employment
- AMPM 1240-J – ALTCS Employment Services
- AMPM 1022 – Justice System Reach-In Program
- ACOM 303 – Community Reinvestment
New Policies Coming in 2024
- AMPM 320-H – Housing
- AMPM 1240-K – Supported Community Connections
- AMPM 320-H2 – Housing and Health Opportunities (H2O) Services Policy