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Arizona - Medical Assistance

crazyquilt started this conversation
Apr 17, 2010

An integral component of promoting the safety, well-being, and self-sufficiency of children, adults, and families in Arizona is in ensuring access to health care services. To this end, the Department of Economic Security (DES), in partnership with the Arizona Health Care Cost Containment System (AHCCCS), determines individuals’ eligibility for Medical Assistance.

The medical coverage provided by AHCCCS to thousands of Arizonans each year may include doctor’s office visits, physical exams, immunizations, prenatal care, hospital care and prescriptions.

Many individuals who qualify for medical assistance are also likely having difficulty meeting other basic needs - such as food and shelter. While applying for Medical Assistance the same application may be used to apply for Nutrition Assistance and Cash Assistance. Therefore, families only have to provide information once in order to determine if they are eligible for multiple types of services that may enhance their family's well-being.

 
Eligibility

There are several types of medical assistance with different eligibility criteria, mostly dependent on the individual or family’s income and resources and residency in Arizona. Under state and federal laws, individuals who qualify for medical assistance – except for Federal Emergency Medical Assistance – must be either U.S. citizens or qualified immigrants. 

In some cases, individuals who earn too much to qualify for medical assistance may qualify for a "spend down" program. The spend down program considers allowable medical expenses and may qualify the individual under lower income limits.

Individuals can pre-screen their eligibility for many health and human service programs – including medical assistance – on-line at: www.arizonaselfhelp.org.

More detailed program-specific eligibility requirements are also available in the DES Family Assistance Administration (FAA) Policy Manual, located on-line. 
 
Applying For Services
Apply for benefits on-line at www.HealthEArizona.org or complete the Application for Benefits (FA-001) form and return it to the local office that serves your ZIP Code. When renewing your benefits, completethe shorter Renewal Assistance Application (FA-001-M) form  (145 KB DOC). Applications may be obtained at any Family Assistance Administration (FAA) local office or on the DES Forms Library. To locate the FAA office closest to your residence go to the FAA Office Locator. 
Fees
There are no fees for applying for medical assistance. Some medical assistance programs may require the participant to make a co-payment when receiving medical services.  The co-payment may be waived by the medical provider.  The KidsCare program does require payment of monthly premiums.
Performance or Accomplishments
  • In fiscal year 2008, DES processed approximately 1,361,400 initial applications to determine eligibility for medical assistance.
  • In fiscal year 2008, DES family assistance staff completed approximately 925,500 re-determination applications (individuals receiving medical assistance must have their eligibility re-determined every six months).
Common Myths
 
Myth: Individuals and families who have health insurance coverage are not eligible for medical assistance. Myth: You have no choice in health plan or physician when you have medical assistance coverage.
Fact: Individuals and families who are covered by health insurance may be eligible for AHCCCS medical coverage when they meet all other program criteria.  AHCCCS then becomes the secondary provider of medical coverage. Fact: The individual may select a health plan when applying for medical assistance.  When they are determined eligible for medical assistance, the health plan will provide them with information on how to select their primary care provider.
 
More Information Contact

Additional information may be obtained in person by visiting or through the mail by writing to any local DES-FAA office (located in the blue pages of the phone book under Department of Economic Security – Family Assistance); by phone at (602) 542-9935 or toll-free statewide at 1-800-352-8401.

To locate the Family Assistance Administration (FAA) office closest to your residence: Office Locations.

To view your health plan, link to your health plan's site, check your MA eligibility status, verify your address, view your annual enrollment date, and other MA related information:  www.myahcccs.com.
Appeals

An appeal may be requested for any eligibility determination including when an application is denied or not acted upon in a timely manner or when benefits are stopped.

The request for an appeal should be made within 30 days of receipt of the determination notice.  Appeals may be requested verbally or in writing.

To request a fair hearing:

  • Complete the Fair Hearing Request Form (30 KB PDF).  The forms are also available at the local DES offices.
  • The statement requesting a fair hearing should include the person’s name, address, the date of the notice they disagree with, and the reason why they disagree with the decision in the notice.
  • The Fair Hearing Request Form or written statement requesting a fair hearing may be submitted in person, by mail, or by fax to the local DES-FAA office.
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