AHCCCS Secure Email Request: mcdumemberescalation@azahcccs.gov
Please include:
- * AHCCCS ID Number(s)
- * Date of Birth
AHCCCS Mail Request: 801 E Jefferson St. MD 3400 Phoenix, AZ 85034
Please include:
- * AHCCCS ID Number(s)
- * Date of Birth
Member Contact Verification Telephone Phone:
- * 602-417-7000
- * 800-962-6690
Eligibility Information
The processing period begins the day after the application date and ends on the date that the decision letter is mailed. For the application to be timely, the letter must be mailed within the processing time frame.
The mailing date is the first business day after the decision has been processed in the system. Letters are printed after close of business on the date of the decision and mailed the following work day.
When the processing period ends on a weekend or holiday, the letters are mailed prior to the weekend or holiday.
| If the customer is applying for: | Then the processing period is... |
|---|---|
| SSI-MAO or FTW based on disability | 90 calendar days from the application date |
| MSP | 45 calendar days from the application date |
| BCCTP | 7 calendar days from the application date |
| Medical Assistance and is pregnant | 20 calendar days from application date |
| Medical Assistance and is hospitalized | 7 calendar days from the application date Note: Only if there no proof or other information needed for the determination. If there is anything still needed, the timeframe is 45 days |
| All other programs | 45 calendar days from the application date |
Processing Period Extensions
The application processing period may be extended beyond the processing time frame when:
- The customer’s income is over the limit for the application month and the following month, but there is a reasonable expectation that the customer will be income-eligible in the third month;
- When the customer appears to be eligible but documentation from a third-party is needed to make the eligibility determination and the third party has not responded. The customer and eligibility worker must continue to take all actions needed to get the information;
- When a for a Policy Clarification Request (PCR) is needed that will affect the eligibility decision;
- When a Disability Determinations Services Administration (DDSA) decision is pending; or
- When the customer requests more time to get documentation or proof needed for the eligibility decision.
Determination and Eligibility Begin Dates
In general, eligibility for AHCCCS Medical Assistance is determined on a month-by-month basis. A customer may be eligible or ineligible for any specific month.
Rules that affect all programs:
- For a person that moves to Arizona from out-of-state, Medical Assistance eligibility cannot start any earlier than the date of the move to Arizona.
- For a person that has been in jail, prison or another detention facility, Medical Assistance eligibility cannot start any earlier than the date the person no longer meets the definition of an inmate.
- For a newborn child, Medical Assistance eligibility cannot start any earlier than the newborn’s date of birth.
Otherwise, the date eligibility starts varies by program. See the table below:
| Program | Eligibility Begin Date |
|---|---|
| Medicare Savings Program (MSP) – QMB | QMB eligibility begins with the month following the month that QMB eligibility is determined. |
| Breast and Cervical Cancer Treatment Program (BCCTP) | BCCTP eligibility begins on the later of:
|
| KidsCare |
|
| All other programs | First day of a month, if the customer is eligible at any time during that month. |
Difficulty of Care Income Exclusion
Some individuals receive income because they provide personal care or attendant care to an ALTCS (Arizona Long Term Care Services) member who resides in their home. The monies (income) received for providing personal care or attendant care services are NOT counted toward AHCCCS eligibility in some instances.
Income is usually included when determining Medicaid eligibility, however, income earned for providing attendant care or personal care services to an ALTCS member living in the same home is considered a Difficulty of Care payment. Income that meets the conditions of a Difficulty of Care payment is not counted against eligibility for some AHCCCS programs.
AHCCCS uses electronic sources to obtain income information. These sources do not identify income from providing attendant or personal care to an ALTCS member living with the caregiver as difficulty of care payments. Therefore, these payments may not have been excluded in the income calculation.
If you receive Difficulty of Care payments and have been denied or discontinued for being over the income limit, please contact AHCCCS at 602-417-5010 to report this income as Difficulty of Care income.
For tax purposes, if you need to verify that the person you are caring for is enrolled in ALTCS, please contact us by phone or email.
Phone: (602) 417-4230
Toll Free: (855) 842-7619
E-mail: dmpsocaservicedesk@azahcccs.gov
1. Renewal Process (except ALTCS – see #2 below)
Renewal for eligibility is completed every 12 months. Approximately 60 days before the end of the 12th month, a renewal is created using eligibility data from the prior application. Then electronic data from Federal and State sources are obtained. With this information, eligibility rules are applied. If the person is still eligible, an approval letter is sent. These are known as No Response Renewals.
If eligibility cannot be determined using available data or the information indicates that the customer is no longer eligible, the customer must provide information needed to complete the renewal process. The customer is sent a pre-populated renewal form with a Request for Information letter describing the information needed to complete the renewal. These are known as Response Required Renewals. Customers who do not provide the requested information by the due date will have their eligibility stopped. If the additional information is received, eligibility rules are applied. If the person is no longer meeting the eligibility criteria in their current program, they will be screened for possible eligibility for all other programs except ALTCS. In the end the customer will receive either an approval letter or a discontinuance letter.
2. For ALTCS customers
Renewal for eligibility is completed every 12 months. Approximately 60 days before the end of the 12th month, a renewal is created using eligibility data from the prior application. Then electronic data from Federal and State sources are obtained. With this information, eligibility rules are applied. If the person is still eligible, an approval letter is sent. These are known as No Response Renewals.
If eligibility cannot be determined using available data or the information indicates that the customer is no longer eligible, the customer must complete an interview with an ALTCS financial worker. After the interview, the customer is sent a pre-populated renewal form with a Request for Information letter describing the information needed to complete the renewal. These are known as Response Required Renewals. Customers who do not provide the requested information by the due date will have their eligibility stopped. If the additional information is received, eligibility rules are applied. The customer will receive either an approval letter or a discontinuance letter.
Customer Assistance
If needed, eligibility workers and other staff will help the customer with the renewal process. Customers can also have someone of their choice help them with the renewal process. This includes:
- Going with the customer to the local office;
- Helping the customer fill out the application; and
- Representing the customer
Customer Cooperation
Customers and their representatives must cooperate in the renewal process. This includes:
- Providing information;
- Reporting changes; and
- Taking any action needed to qualify for the MA program
Opportunity to Register to Vote
The National Voter Registration Act (NVRA) of 1993 and Arizona Revised Statue (ARS) require that public assistance offices provide applicants and customers with an opportunity to register to vote at the time of renewal.
Guaranteed Enrollment Periods
Customers are eligible for a guaranteed enrollment period should they become ineligible for AHCCCS. The guarantee period is calculated at the time of the discontinuation. Customers receiving Medicare Savings Program (MSP) coverage only do not have guaranteed enrollment periods.
For customers enrolled with an AHCCCS Complete Care (ACC) health plan for the first time, the guaranteed enrollment period is six months unless one of the following occurs:
- Moves out of state;
- Cannot be located and mail is returned to the agency as undeliverable;
- Is incarcerated;
- Is adopted;
- Was ineligible at the time of initial enrollment; or
- Voluntarily withdraws from the program.
For customers who are under age 19 when approved or at renewal, the guaranteed enrollment period is 12 months unless one of the following occurs:
- Reaches age 19;
- Moves out of state;
- Was approved or renewed in error, or
- Voluntarily withdraws from the program.
For customers who are under age 19, currently in KidsCare, and screen eligible for a higher medical eligibility program, the guaranteed enrollment period is 12 months. Additionally, the renewal date for this customer and all other household members will be reset for 12 months later.
The guaranteed enrollment period for these customers can be discontinued if one of the following occurs:
- Reaches age 19;
- Moves out of state;
- Was approved or renewed in error, or
- Voluntarily withdraws from the program.
- Is a DCS customer
Additionally, the renewal date for this customer and all other household members will be reset for 12 months later to keep the household's renewals at the same time.
Don’t wait for the mail to be delivered! Sign up for paperless delivery of your AHCCCS letters and alerts. Get easy access to news, alerts, and letters from AHCCCS as soon as they are sent. All you need is a Health-e-Arizona Plus online account.
If you don’t have one, create one today on Health-e-Arizona Plus at www.healthearizonaplus.gov.
In Health-e-Arizona Plus, you can: See letters about benefits, Choose to stop getting paper letters by U.S. mail, Sign up for alerts by text message, email, or both, Report address and other changes, See the status of your application, Renew benefits and coverage, and Manage your account.
Once you have an account, going paperless is easy!
- Log in to Health-e-Arizona Plus www.healthearizonaplus.gov.
- Go to “Message Center” on the toolbar.
- Click on “Manage My Alerts and Letters.”
- Choose the preferred letter and alert options. You may choose email, text, or both.
Need more help? See the Go Paperless flier for screen shots of how to subscribe.
How do I report changes?
If you need to report a change in your household including, but not limited to, a change of residential or mailing address, your income, household member's change of job, etc., contact the eligibility source where you applied for AHCCCS:
- DES www.healthearizonaplus.gov or 1(855)HEA-PLUS (1-855-432-7587)
- KidsCare www.healthearizonaplus.gov or 1(855)HEA-PLUS (1-855-432-7587)
- SSI MAO www.healthearizonaplus.gov or 602-417-5010/1-800-528-0142 Outside Maricopa County
- Social Security Administration (1-800-772-1213)
- ALTCS Local Offices
How do I report changes for my newborn?
Has AHCCCS sent you a text message, email, or voicemail asking you to update your newborn's information? Click chat.healthearizona.gov to get started.
