Is Ahcccs Medicaid Or Medicare


Ahcccs Medicaid Program Is Available For Low Income Individuals And Familys

AHCCCS: Overview & New Changes

The income limit in Arizona is less than $1,067 for an individuals or $1,437 for a couple per month.

An AHCCCS plan works like an HMO plan with a network of doctors contracted to provide services. A Primary Care Physician would need to give a referral to see a specialist. AHCCCS plans cover most basic medical needs including doctors visits and hospital services, labs and x-rays, immunizations, emergency care, and specialists.

Medicaid For Disabled And Elderly Residents

ALTCS is a state Medicaid program that can help certain individuals afford their medical care. This system provides specifically for the long-term medical needs of qualifying disabled, blind, or aged residents in the state. This program pays for the services you require once youve already exhausted your savings. To qualify, you must undergo a financial assessment to determine whether you are able to cover the costs yourself. The next component is a functional assessment to determine your current medical state and care needs.

The financial eligibility requirements to receive ALTCS benefits can be complicated and will be affected by whether or not youre married. As a single applicant, you can earn $2,382 or less in monthly income to qualify. If youre married and applying for benefits on your own, your income is limited to the same amount and your spouses income doesnt count. If you and your spouse are applying for ALTCS together, you may not earn more than $4,626 monthly.

If your income is higher than these numbers, dont let that deter you from pursuing ALTCS services. You might still be able to qualify for benefits by using a Miller Trust. Like other trusts, this type of trust must be legally sound in order to be considered valid.

How We Can Help

New To medicare

If you are new to Medicare this is a stressful part of life to deal with. Our agents know the exact process on helping you find the right Medicare plan.

Already on Medicare

Our needs change over the years. If you are looking for a new Medicare plan, we are more than happy to assist with that.


There are special Medicare plans for those that have AHCCCS. We know all about them. We can also help you get qualified for AHCCCS.

In Person visits

Some people learn best when seeing the material in person. If this is you, all of our agents are happy to meet with you in person at your home or your choice of a public place.

Video chat

If meeting in person is not convenient, our agents can also do a video chat. This a another beneficial way of hearing and seeing the material.


Scheduling an appointment by telephone is also easy and convenient. Our agents are trained to be thorough while also being able to help with a clear understanding.

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Current News Bulletins And Alerts

Arizona Medicaid: Use the correct place of service code to avoid claim denials for telehealth services

To avoid a claim denial, ensure youre using the correct place of service code when providing telehealth services for UnitedHealthcare Community Plan members.

Arizona: Appointment availability surveys

The Arizona Health Care Cost Containment System requires Unitedhealthcare to conduct quarterly phone surveys to help ensure the care providers in our network are complying with state appointment availability guidelines. We submit survey results to AHCCCS and the Division of Developmental Disabilities .

New online course for providers treating patients with IDD

A new online course for providers who serve individuals with intellectual and developmental disabilities is available now.

Arizona: New RHC/FQHC school billing guidelines effective Jan. 1, 2022

The Arizona Health Care Cost Containment System updated its billing guidance for school place of service.

Arizona Medicaid: Update to fraud and abuse requirements

The Arizona Health Care Cost Containment System has updated its fraud and abuse requirements for health care professionals and subcontractors, effective Oct. 1, 2021.

Arizona Medicaid: Use the correct place of service code to avoid claim denials for telehealth services

To avoid a claim denial, ensure youre using the correct place of service code when providing telehealth services for UnitedHealthcare Community Plan members.

How To Report Fraud Waste Or Abuse To The State Of Arizona

Upcoming Medicaid (AHCCCS) Change Requires Member Response ...

The Office of Inspector General for the State of Arizona provides a way for members, plans, providers, and the public to report all forms of suspected fraud, waste or abuse of the program. We encourage medical professionals and their staff to review the information available on the AHCCCS website.

UnitedHealthcare Dual Complete® Special Needs Plan

UnitedHealthcare Dual Complete Special Needs Plans offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.

Also Check: How To Qualify For Medicaid In Nevada

How Much Can You Make And Keep Ahcccs

In the 1619 program, people on SSI can work and keep AHCCCS, even if they earn too much money to qualify for SSI cash benefits. The premiums for this program will not be required if you are on it. Those who live in Arizona and are on SSI and AHCCCS can have up to $41,015 in gross income and remain on AHCCCS even if they lose their SSI benefits.

Who Can Receive Services

AHCCCS offers medical programs and resources to serve Arizona residents who meet certain income and other requirements.

  • Families With Children
  • Individuals Who are 65 or Older
  • Individuals Who are Blind or Have a Disability
  • Individuals Who Require Nursing Home or In-Home Care
  • Individuals With Developmental Disabilities who Need Long Term Care
  • Individuals Who Need Help Paying Medicare Costs Only
  • Individuals With High Medical Expenses
  • Women Who Want Screening for Breast or Cervical Cancer
  • Working Individuals With a Disability
  • Small Business Owners

A full list of eligibility requirements and application information can be found on the Arizona Health Care Cost Containment System website.

Read Also: Medicare Part D Medicaid Dual Eligibles

Who Qualifies For Ahcccs Medicaid

To be eligible for Arizona AHCCCS Medicaid, you must:

  • Be an Arizona Resident and a United States citizen or qualified immigrant.
  • Have, or be eligible for, a Social Security number.
  • Have a limited income.
  • Be a senior, age 65+, or approved for Supplemental Security Income , based on disability, by the Social Security Administration.

The gross monthly income limit as of January 2021 was $1,415 for a single applicant and $1,911 for a family of two.

for additional information on eligibility.

How Do I Submit A Claim Availity

How the AHCCCS Addresses the Long-Term Care Needs of Tribal Medicaid Members

How do I send claims to Availity ? Create a claim file using your current billing software. Click EDI File Management/Send and Receive EDI Files. Click the Send Files mailbox. Browse your computer for the batch claim file and click on it. Click Upload File Availity sends the claims to the appropriate payers.

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Read Also: What Age To Apply For Medicaid

Reporting Fraud Waste Or Abuse To Us

When you report a situation that could be considered fraud, youre doing your part to help save money for the health care system and prevent personal loss for others. If you suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it.

Taking action and making a report is an important first step. After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system.

Call us at 1-844-359-7736 or visit to report any issues or concerns.

How Do I Enroll In Medicaid In Arizona

The quickest way to apply for AHCCCS is online at

Or you can enroll through if you are a non-disabled person under age 65.

You can also print an Application for Benefits form, complete it, and submit it by mail or in person. Use the locator tool to find a nearby office.

If you need help completing an application, call 1-855-HEA-PLUS or search online for a community assister.

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Unitedhealthcare Dual Complete One Contact Information

Mailing Address

1 East Washington, Suite 900Phoenix, AZ 85004

Claims & Medical Records Mailing Address

UnitedHealthcare Community Plan

Behavioral Health Claims & Medical Records Mailing Address

United Behavioral HealthSalt Lake City, UT 84130-0760

Provider Claim Disputes Mailing Address

UnitedHealthcare Dual CompleteSalt Lake City, UT 84131-0364

Part C Member Appeals and Grievance Department

Attn: CA124-0187

Part D Member Appeals and Grievance Department

Attn: CA124-0197

Credentialing and Attestation

For more information about the credentialing process for network care providers, please read the AHCCCS Credentialing Tip Sheet. You can also visit > Step 2: Get Credentialed for additional credentialing resources and information.

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Member dental plan and benefit information can be found at and

Arizona Ahcccs Complete Care / Medicaid Contact Information

AHCCCS Medicaid provides low and no

Mailing Address

1 East Washington, Suite 900Phoenix, AZ 85004

Claims & Medical Records Mailing Address

UnitedHealthcare Community Plan

Behavioral Health Claims & Medical Records Mailing Address

United Behavioral HealthSalt Lake City, UT 84130-0760

Provider Claim Disputes Mailing Address

UnitedHealthcare Community Plan1 East Washington, Suite 900Phoenix, AZ 85004

Developmentally Disabled Services Contact Information

Mailing Address

1 East Washington, Suite 900Phoenix, AZ 85004

Claims & Medical Records Mailing Address

UnitedHealthcare Community Plan

Behavioral Health Claims & Medical Records Mailing Address

United Behavioral HealthSalt Lake City, UT 84130-0760

Provider Claim Disputes Mailing Address

UnitedHealthcare Community Plan1 East Washington, Suite 900Phoenix, AZ 85004

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Financial Eligibility Requirements For Altcs

To determine ALTCS eligibility, AHCCCS looks at both your monthly income and countable resources.Countable income includes:

  • Real property
  • Stock, bonds, and certificates of deposit

AHCCCS does not count the home you live in, household and personal belongings, one vehicle, burial plots, and up to $1,500 designated for burial.

Macluumaadka Bixiyaha Ee Muhiimka Ah

Go’aanka Adigaa Leh.

Waxaan ku siin doonaa macluumaad kaa caawin doona inaad gaarto go’aano wargal ah, sida aqoonsashada dhakhaatiirta iyo xirfadleyaasha daryeelka caafimaadka. Macluumaadkan, si kastaba ha ahaatee, ma ahan mid ayidaya dhakhtar gaar ah ama xirfadlaha daryeelka caafimaadka ee ku habboon baahidaada.

Bixiyeyaasha la heli karo iyadoo loo marayo codsigan ma ahan inay xaqiiqdii uga turjumayaan si buuxda shabakada UnitedHealthcare ee bixiyeyaasha qandaraaska lagula jiro. Waxaa laga yaabaa inay jiraan bixiyeyaal ama takhasusleyaal gaar ah oo aan lagu darin codsigan oo qayb ka ah shabakadeena. Haddii aadan helin bixiyaha aad raadinayso, waxaad si toos ah ula xiriiri kartaa bixiyaha si aad u xaqiijiso xaaladda kaqaybgalka ee shabakadda UnitedHealthcare, ama kala xiriir Mamber Services lambarka bilaashka ah ee ku qoran kaarkaaga aqoonsiga UnitedHealthcare. Waxaan sidoo kale kugula talineynaa, kahor inta aadan la kulmin dhakhtar kasta, oo ay ku jiraan takhasusleyaal kasta, inaad wacdo xafiiska dhakhtarka si aad u xaqiijiso xaaladda kaqaybgalka iyo helitaanka.

Qaar kamid ah shabakadda bixiyeyaasha ayaa laga yaabaa in lagu daray ama laga saaray shabakadeena kadib markii diiwaankan la cusbooneysiiyay. Ma dammaanad qaadi karno in bixiye kasta weli aqbalayo xubno cusub.

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Gift Card For Medicaid Members Who Get A Flu Shot

It is more important than ever to get a flu shot this winter. Please see your health care provider or go to an in-network pharmacy to get your flu shot. When your Medicaid vaccination claim is processed, a $10 Walmart gift card will be mailed to the address you have on file with AHCCCS. For more information contact Member Services at .

Arizona Lawmakers Have Pushed For Changes To Medicaid Eligibility And Benefits Since 2015

Bogutz & Gordon – Medicaid & Medicare, AHCCCS & ALTCS

In the 2015 legislative session, Arizona lawmakers passed Senate Bill 1092, which made an effort to dial back the states expansion of Medicaid. SB1092 requires the state to submit an 1115 waiver request to CMS every year, asking for approval for new Medicaid eligibility guidelines.

Lawmakers wanted the new eligibility rules to include a five-year limit on Medicaid coverage for able-bodied adults, along with a provision requiring enrollees to be working or involved in job training or school. In August 2015, Governor Doug Ducey unveiled his proposals for Arizonas first Medicaid waiver proposal, including a work requirement and the five-year lifetime limit on Medicaid coverage for able-bodied adults. The idea was that Medicaid would remain a solid safety net for children and disabled adults, but that it would become a more temporary program for able-bodied adults. Duceys waiver proposal also included a requirement that enrollees pay increased premiums and cost-sharing and establish health savings accounts, and participate in various wellness programs like flu shots and glucose screening.

Many advocates for low-income Arizona residents were worried that Duceys proposal would be a setback, chipping away at the hard-won gains the state has made in reducing the uninsured rate.

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A Good News Reminder For Our Mercy Care Advantage Members Who Are Also Enrolled In Mercy Care

ONE plan, ONE card is all you needIf you are enrolled in Mercy Care Advantage and Mercy Care, you will only need to show ONE card to receive your Medicare and Medicaid plan benefits when you visit your health care providers. Heres how it works:

  • Show the provider your MCA card. Thats the one that has the MCA logo on it, plus the Mercy Care logo and the AHCCCS logo.
  • If the provider asks for another ID, show your Arizona drivers license or state-issued ID card.
  • You do NOT need to show your AHCCCS card as well.
  • Other Medicaid Plan CoverageIf you have Mercy Care Advantage for your Medicare coverage but receive your Medicaid coverage from a plan other than Mercy Care, you will need to show both your MCA ID card and your Medicaid plan ID card to your health care providers so they can submit claims to both your health plans.

    Your MCA card also tells you how AHCCCS can protect your identity. They do this by using the picture on your drivers license or state-issued ID to verify who you are. Then they add your picture to the online tool that providers use to verify your coverage. Your providers can see your picture and verify your benefits.

    What do you do if you need a new member ID card?Just call Member Services at the phone numbers at the top of the page.

    Medicare Vs Medicaid: What You Need To Know

    Although similar in name, the Medicare and Medicaid programs vary in the health services they provide, and the populations to which they are provided. At a glance, Medicare primarily serves older adults over 65 and individuals with disabilities, while Medicaid serves low-income individuals and families of any age. Learn more about these two programs and how DES can assist you.

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    Does Medicaid Cover Dental In Arizona

    Arizona Medicaid Dental coverage for Adults Arizona adults who are enrolled in MediCaid Access receive emergency dental care. Medicaid in Arizona does not cover exams, x-rays, cleanings or other preventive dentistry . For complete coverage details, visit the Arizona Healthcare Cost Containment System site.

    Rick Randall

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    Im An Immigrant Can I Get Ahcccs

    • Undocumented immigrants do not qualify for full AHCCCS coverage, but they may qualify for AHCCCS coverage for emergency services.
    • Most immigrants who have been legal residents for less than 5 years do not qualify for full AHCCCS coverage. However, they may qualify to get private coverage subsidized by the government.
    • Immigrants who have been legal residents for 5 years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that citizens can get.

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    The Ahcccs System Of Managed Care

    AHCCCS has developed three separate managed care systems. The first and largest is made up of 11 health plans that provide primary and acute care services to beneficiaries who do not receive long-term care services. The second system is a group of five behavioral health firms that provide mental health services to this same population.19 The third system comprises eight health plans that care for just over 25,000 recipients of long-term care services. These plans provide clients with all services: case management, primary and acute care, behavioral care, and long-term care.

    The large majority of AHCCCS beneficiaries are enrolled in one or more of these managed care systems. In late 1997, for example, just over 81 percent of all AHCCCS enrollees were in managed care. The only groups that are permitted to stay in fee-for-service medicine are Native Americans, children in foster care, persons residing in institutions other than nursing homes, and persons eligible to receive only emergency services.

    The rise in the autoassignment rate has raised concern among consumer advocates and some state officials. The concern is accentuated because the state has a 12-month lock-in period: Clients who do not opt out of their plan within the first 16 days are generally required to stay in the plan for 12 months.20

    Paying Managed Care Plans: The Competitive Bidding Process

    Table 4 Managed Care Enrollment by Health Plan, April 1, 1999

    Materials received from AHCCCS.

    New Outpatient Physical Therapy Benefit For Adult Ahcccs Members Beginning March 1 2014

    • PDF 84.83KB – Last Updated: 11/12/2020

    Changes to Some Co-payments Beginning January 1, 2014

    Beginning January 1, 2014, there will be changes to co-payments for some AHCCCS members that are not in the Member Handbook. Read the Co-payment section of the Member Handbook for information about other Co-payments. Here are the changes to co-payments that are not in the Member Handbook and that will start on January 1, 2014.

    Notice of Co-pays for Taxi Rides – Effective February 2012

    For AHCCCS Care Members in Maricopa and Pima counties.

    • PDF 203.73KB – Last Updated: 11/12/2020

    Missed Appointment Fee – Effective January 2, 2012

    There will be a missed appointment fee for members living outside of Maricopa and Pima counties. Click here for the AHCCCS website.

    • PDF 572.28KB – Last Updated: 11/12/2020

    Motor Vehicle Division Photos

    To help protect your identity and prevent fraud, AHCCCS is adding pictures to its on-line verification tool that providers use to verify your coverage. If you have an Arizona drivers license or state issued ID, AHCCCS will get your picture from the Arizona Department of Transportation Motor Vehicle Division . When providers pull up the AHCCCS eligibility verification screen, they will see your picture with your coverage details.

    Nationwide Vision is New Provider – Effective November 1, 2011

    UnitedHealthcare Community Plan has a new agreement with Nationwide Vision to provide vision care services for our members, beginning November 1, 2011.

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