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AHCCCS Encourages Parents to Apply for KidsCare Health Insurance

In March, AHCCCS sent letters encouraging 1,926 parents of children who had been discontinued from KidsCare health care coverage to re-apply. As many as 3,000 children who were previously ineligible may now be eligible due to an increase in the upper income limit of the program.

“The expansion of KidsCare demonstrates AHCCCS’ commitment to its community and members’ needs,” said AHCCCS Cabinet Executive Officer Carmen Heredia. “As more children in Arizona receive coverage, the healthier our communities can be, especially our families.”

In 2023, the Arizona Legislature passed, and Governor Hobbs signed, a bill to increase the income limit for KidsCare eligibility to 225% of the federal poverty level. In 2024, AHCCCS received federal approval to make this change permanent. With this approval, Arizona has become the first state in the nation to expand CHIP financial eligibility through its federal five-year 1115 Waiver approval process.

To apply for KidsCare please create an online account on Health-e-Arizona Plus or call 1-855-432-7587 for assistance.
Return to Regular Medicaid Renewals Enters Final Month

AHCCCS released its monthly Medicaid renewal data dashboard reporting progress of unwinding from the continuous enrollment afforded most members during the COVID-19 Public Health Emergency (PHE).

By the end of March, AHCCCS initiated renewals for all the 2.5 million members who were enrolled when the PHE ended last year. To date, 67% have maintained coverage, 20% have been disenrolled, and 13% are still in process.

“I’m extremely proud of the agency’s efforts this year regarding eligibility renewals, the successful implementation of our PHE unwinding plan, and the collaboration and support from our health plans and community partners for their outreach to AHCCCS members statewide,” said AHCCCS Deputy Director Kristen Challacombe. “Not only did we meet our legislative mandate to complete renewals by Dec. 2023 for all individuals who were likely no longer eligible, but we also created AHCCCS Connect, a brand new process to communicate with members by text, email, and phone throughout their Medicaid lifecycle so they are more engaged with us when action on their part is needed.”

Of those members who were disenrolled for not responding to the agency’s request for information, 59% of those who used the 90-day grace period to complete their renewal request and remained eligible for coverage without having to reapply.

AHCCCS maintains a “heat map” dashboard detailing areas of the state by zip code and level of risk of losing coverage due to a failure to complete annual renewals. This map is yet another way AHCCCS is providing transparency and information that stakeholder communities can use to strengthen awareness, education, and outreach efforts.

The various colors indicate risk levels ranging from 1-12 (lowest to highest) based on the number of active AHCCCS members, the current percentage of procedural discontinuances for response required renewals, and the number of remaining renewals.

Find the renewals dashboard and heat map on the AHCCCS Return to Regular Renewals web page.
Community Health Worker Organizations Added as an AHCCCS Provider Type

AHCCCS announced that organizations that employ certified Community Health Workers (CHWs), also referred to as Community Health Representatives or Promotores de Salud, will be able to register as AHCCCS providers and be reimbursed for providing Medicaid services.

CHWs are an integral part of community health, serving as a liaison between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, including the coordination of services to improve medical and behavioral health outcomes.

With this addition as a provider type, CHW organizations will be required to submit a list of all certified CHWs whom they employ, adhere to all relevant AHCCCS policies when billing for CHW services, and be certified by the Arizona Department of Health Services (ADHS).

More information, including the AHCCCS policy and Frequently Asked Questions about CHWs and registering for Medicaid reimbursement, is on the Community Health Worker web page.
Final Public Notice Posted for Contract Year 2025 Differential Adjusted Payments 

AHCCCS has published the Contract Year End (CYE) 2025 Differential Adjusted Payments (DAP) Final Public Notice on the Differential Adjusted Payment web page, with rates effective for dates of service beginning October 1, 2024 through September 30, 2025.

The DAP is a positive adjustment to the AHCCCS Fee-for-Service (FFS) rates to distinguish providers who have committed to supporting designated actions that improve patients’ care experience, improve members’ health, and reduce cost of care.

AHCCCS health plans are required to pass through DAP increases to their contracted rates to match the corresponding AHCCCS FFS rate increase percentages.

Subscribe to DAP email alerts to receive notifications and updates. 
New Enterprise Workflow System Starts with Release of First Module in June

In June 2024, AHCCCS will introduce a new enterprise workflow system designed to improve the way applicants, members, providers, and health plans interact with AHCCCS when filing grievances, help desk tickets, and more.

The first module will allow users to submit a grievance or hearing request to the Office of the General Counsel, add additional documents related to hearings, and track progress online.

AHCCCS will provide updates as the project progresses.
AHCCCS Earns Slot in Competitive Technical Assistance Opportunity 

The U.S. Department of Health and Human Services (HHS) and Department of Housing and Urban Development (HUD) selected Arizona as one of the eight states and the District of Columbia (DC) to participate in a new federal initiative known as the “Housing and Services Partnership Accelerator” (Accelerator), designed to strengthen partnerships across housing, disability, aging, and health sectors; access available federal programs and resources; and maximize federal flexibilities to help keep people healthy.

The Accelerator will help Arizona unlock critical resources to reduce homelessness by addressing health-related social needs, such as housing-related services. The program provides technical assistance to states implementing HHS’ recently issued guidance regarding clinically appropriate and evidence-based services that can be covered under Medicaid and the Children’s Health Insurance Program (CHIP). 

Through this program, Arizona seeks to 
  • Enhance and expand the state’s existing knowledge around housing services and interventions for those who are experiencing homelessness and those who are at risk of becoming homeless, 
  • Support housing and service providers to better identify fund sources to help cover the cost of additional housing and support services for eligible populations, and
  • Maximize housing stability for Medicaid members by providing wraparound services using the H2O waiver, Arizona Long Term Care System (ALTCS), and State Unit on Aging home and community-based services. 

AHCCCS staff presented at the Arizona Public Health Association (AZPHA) Opioid Conference about the agency’s efforts to address the state’s ongoing opioid epidemic.

AHCCCS staff pictured (left to right): Lea Hollis, Carmen Heredia, Kate Dobler, Polly Knape, Shannon Ambur, Marisa Sanchez, Cassandra Lim, Emma Hefton, and Bianca Arriaga.

Learn more about our efforts and what resources are available to help combat this epidemic on the AHCCCS website.
CEO Heredia joined March of Dimes to celebrate the opening of a new Mom and Baby Mobile Center that will bring a proven model of care to those in need throughout the greater Phoenix community and help us reduce health disparities.
Community Forum
Mon. April 15, 10:00 a.m.—12:00 p.m., online on Zoom
Learn about the newly established provider type “Community Health Worker/Community Health Representatives (CHW/CHR) Organizations” and services they provide, Enhanced Shelter Rates for H2O, and Updates to the Arizona Olmstead Plan.

OIFA Health Care Navigation
Tues., April 23, noon—12:30 p.m., online on Zoom
AHCCCS members are eligible to receive medically necessary behavioral health services. Join OIFA to learn how to access behavioral health services and what services are available to members.

Office of Human Rights Training Session: The Individualized Service Plan and Why it Matters for Individuals Living with a Serious Mental Illness
Thurs., April 25, 1:00 p.m. - 2:30 p.m., online on Zoom
This training will focus on the policies and requirements for the Individualized Service Plan (ISP) and Why it Matters as it pertains to Individuals Living with a Serious Mental Illness. The information will review what it is and how the requirements improve treatment outcomes.

Jacob’s Law Training 
Thurs., April 25, 11:00 a.m.—1:00 p.m, online on Zoom
This training will cover Jacob’s law, review and use of the DCS placement packet, legal rights and protections of children and resource parents, and covered services. Training length is two (2) hours. Certificates and two (2) Continuing Education Units (CEUs) are available upon request after attending the full presentation.

Fee-for-Service Provider Training Classes in April
Training classes for Fee-for-Service (FFS) providers every week in March. See the FFS 2nd Quarter Training Schedule. Most classes are recorded and available as videos on the FFS Training Resources web page.

Submitting Documentation Using the Transaction Insight Portal
Tues., April 2, 10:00-11:00 am, online on Zoom
Submitting supporting documents for a claim using the Transaction Insight Portal (TIBCO). 

Submitting a Request for Prior Authorization (AHCCCS Online Provider Portal)
Wed., April 3, 10:00-11:00 am, online on Zoom
How to verify the status and request a prior authorization using the AHCCCS Online Provider Portal. 

AHCCCS NEMT Trip Report, Updates 
Thurs., April 4, 10:00-11:00 am, online on Zoom
How to fill out an NEMT Daily Trip Report, NEMT updates and NEMT billing reminders.

Professional Claim Submission 
Tues., April 9, 10:00-11:00 am, online on Zoom
Wed., April 10, 10:00-11:00 am, online on Zoom
How to submit a claim using the AHCCCS Online Provider Portal. Please note, this training reviews professional claims. 
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Submitting Documentation Using the Transaction Insight Portal
Tues., April 16, 10:00-11:00 am, online on Zoom
Tues., April 23, 10:00-11:00 am, online on Zoom
Submitting supporting documents for a claim using the Transaction Insight Portal (TIBCO). 

Voids and Replacements
Wed., April 17, 10:00-11:00 am, online on Zoom
Overview of how to submit voids and replacements for claims using the AHCCCS Online Provider Portal, and a review of the timely filing requirements for claims.

Office of General Counsel (OGC) Claims Disputes Overview
Thurs., April 18, 10:00-11:00 am, online on Zoom
An overview of what are valid and invalid claim disputes, filing timeframes, and how to avoid filing a claim dispute.

AHCCCS NEMT Trip Report, Updates 
Wed., April 24, 10:00-11:00 am, online on Zoom 
How to fill out an NEMT Daily Trip Report. NEMT Updates and NEMT Billing Reminders.

Participating Provider Reporting Requirements 
Tues., April 30, 10:00-11:00 am, online on Zoom 
This training reviews the reporting requirements for AHCCCS provider types Integrated clinics (Provider Type IC), behavioral health outpatient clinics (Provider Type 77), and clinics (Provider Type 05).

See the AHCCCS Calendar for more scheduled events.