Retroactive Coverage (also called Prior Quarter Coverage)

Beginning July 1, 2019 coverage for most newly eligible members will be retroactive to the first day of the month in which the Medicaid application is received.

Pregnant women and children up to age 19 exempt from this requirement.

If an exempt individual is determined to qualify for AHCCCS during any one or more of the three months prior to the month of application, then the individual will be determined to have “Prior Quarter Coverage” eligibility during those months.

Providers are encouraged to utilize the Health-e-Arizona Plus (HEAplus) application process to assist in enrolling uninsured patients into AHCCCS coverage. HEAplus offers the most accurate, credible, real-time eligibility determinations for public assistance programs such as AHCCCS to help providers better manage their patients’ payment source. HEAplus will shorten the eligibility determination timeframe and simplify the process for members and providers. Anyone can access www.healthearizonaplus.gov from any internet connection. Today, hundreds of locations throughout the State use HEAplus to help Arizonans. More information about HEAplus, including how to become a Contracted Community Partner can be found on the link below:

HEAplus

Frequently Asked Questions about Retroactive Coverage

FAQs

  1. When will the retroactive coverage changes go into effect?
  2. Why is AHCCCS making this change?
  3. How can providers minimize uncompensated care?
  4. What happens if a member has unpaid medical bills that are not covered?
  5. What happens if there is a delay in processing a member’s application?
  6. Does the retroactive coverage policy change affect children?
  7. Does the retroactive coverage policy change affect pregnant women?
  8. Is the KidsCare Program changing as a result of this policy?
  9. Does the retroactive coverage policy change affect American Indian members?

Learn more about 2018 amendments to the AHCCCS 1115 Waiver


For archived documents please see the Plans/Providers/Rates and Billing/Fee for Service/Prior Quarter Coverage section of the AHCCCS Document Archive.