AHCCCS Presents to SMAC: AZ Medicaid Proposal to Waive Prior Quarter Coverage

AHCCCS Presentation to State Medicaid Advisory Committee (SMAC)

The Arizona Health Care Cost Containment System (AHCCCS) is requesting a waiver of the requirement to provide three months of retroactive coverage to new AHCCCS members. AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act. Following public forums, AHCCCS has scheduled its Proposal to Waive Prior Quarter Coverage presentation to the State Medicaid Advisory Committee (SMAC) meeting on February 7, 2018.

Summary

Under current law, if a new AHCCCS member would have qualified for AHCCCS coverage during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, AHCCCS is required to reimburse providers for any AHCCCS covered service received by the member during that period.1 To better align Medicaid policies with commercial health insurance coverage, AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act. Under the proposed policy, individuals will continue to receive retroactive coverage effective as of the first day of the month in which the Medicaid application was filed.

This proposal to waive Prior Quarter Coverage promotes the objectives of the Medicaid program by (1) creating efficiencies that ensure Medicaid’s sustainability for members over the long term; (2) encouraging members to obtain and maintain health coverage, even when healthy; and (3) encouraging members to apply for Medicaid expeditiously when they believe they meet the criteria for eligibility.

Arizona will increase efforts to educate and encourage Arizona residents to apply for AHCCCS coverage.

Read more about this waiver amendment from AHCCCS