State Medicaid agencies already have extensive tools to address managed care plans that fail to meet quality, access, financial or contractual requirements. The bigger challenge may be ensuring states identify and address poor performance by using tools to measure whether interventions produce results.
A September Commonwealth Fund...
The Centers for Medicare & Medicaid Services (CMS) is launching a new initiative Investing in Health Outcomes with 37 states to shift Medicaid quality measurement away from process and paperwork and toward measurable improvements in patients' health.
Inside Health Policy reported that participating states are expected to focus on:...Arizona News
Stakeholders argue the new policy improperly narrows an exemption for medically frail people from the new Medicaid work requirements. The lawsuit, filed Sept. 18 in the U.S. District Court for the District of Maryland, is the second legal challenge to the Centers for Medicare & Medicaid Services’ (CMS) interim final rule...Arizona News
Arizona is preparing for major changes to its Medicaid program that could affect more than 400,000 adults enrolled through the state's Medicaid expansion. The new rules go beyond work requirements. Beginning in 2027, affected Medicaid recipients will have to renew their eligibility every six months versus annually, creating additional...Arizona News
HHS awarded $383.4 million through the Substance Abuse and Mental Health Services Administration to strengthen behavioral health treatment, prevention and crisis response nationwide. Nearly two-thirds of the funding, $252 million, is directed toward the 988 Suicide & Crisis Lifeline, suicide prevention and mobile crisis...Arizona News
According to a new Issue Brief from Georgetown University, new Medicaid work-reporting requirements are likely to confuse low-income parents. Parents who qualify for AHCCCS under Arizona's caretaker relative category are not subject to impending 2027 Medicaid work-reporting requirements.
According to research from ...Arizona News
AHCCCS has opened two Requests for Grant Applications (RFGAs) under the Arizona Rural Health Transformation Program (RHTP). The funding totals $13.5 million and the grants are designed to help rural healthcare organizations share operating costs and expand access to behavioral health and substance-use services.
Arizona received nearly...Arizona News
Medicaid work requirements were included in the One Big Beautiful Bill Act of 2025 (OBBBA) as a means to offset the bill spending, meaning that the goal is for enrollees to lose coverage as a direct result of the program. In Arizona, up to 500,000 enrollees in the Arizona Health Care Cost Containment System (AHCCCS) will be...Arizona News
The Trump administration is proposing a sweeping rewrite of how Medicaid Section 1115 demonstration waivers are financed, replacing decades of negotiated budget neutrality policy with new statutory requirements that will require certification by the CMS Chief Actuary before new waivers, renewals or amendments can be approved. While...Arizona News
The Arizona Health Care Cost Control System (AHCCCS) the state's Medicaid agency, is rolling out a new analytics tool this summer designed to improve claims accuracy, strengthen program integrity and support providers through more efficient claims review.
The system, part of the agency's broader Alivia 360 platform, uses advanced...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) targets new oversight of Medicaid demonstration project spending authorization through Section 1115 waivers. Nearly all states use demonstration waivers, including Arizona.
Late last week, CMS issued the new guidance for upcoming demonstrations beginning January 1, 2027. From that...CMS Rules
The provision getting the most attention in the interim final rule is that HHS declined to give states flexibility to create additional categories of "medically frail" Medicaid beneficiaries exempt from the new work requirements. The agency said the five exemption categories established in federal law are broad enough to cover...Arizona News
On Monday, Arizona Governor Katie Hobbs announced that a new artificial intelligence tool would be deployed to target offenders in the state's largest fraud scandal. The scheme targeting AHCCCS/Medicaid has defrauded the state of at least $2.5 billion and preyed on predominantly Native American individuals battling addiction.
The...Arizona News
Medicaid quality measure reform is gaining momentum in the Trump administration as Centers for Medicare and Medicaid Services (CMS) leaders are raising questions about the abundance of metrics.
Center for Medicaid and CHIP Services Director Daniel Brillman said that the high volume of quality measures is burdensome for states and...
The general public may review and submit comments regarding proposed changes to provisions of the AHCCCS Contractor Operations Manual (ACOM) and the AHCCCS Medical Policy Manual (ACOM), the governing agreements for plans and providers contracted with the Arizona Health Care Cost Containment System (AHCCCS).
Among the most significant...
Left with few places to cut federal spending, the Trump administration has set its sights on home- and community-based services, which officials accuse of being rife with "waste, fraud and abuse."
Home- and community-based services (HCBS) provide for the daily care and activity of elderly people or people with disabilities who are...Arizona News
The new AHCCCS Solutions Center is a centralized platform designed to make it easier for providers and their staff to connect with AHCCCS and submit requests. The agency scheduled several April webinars to introduce users to the new platform.
Arizona's Medicaid agency, the Arizona Health Care Cost Containment System, is hosting a...
Copa Health of Mesa filed a civil lawsuit March 23 against former CEO Sharareh (Shar) Najafi-Piper, her husband Brian Piper and Roya Health, a startup created and operated by the Pipers that Copa Health claims competed with Copa Health. The non-profit alleges misuse of funds.
On January 22, Copa Health board members fired Najafi-Piper...
Arizona is advancing a major overhaul of its Medicaid infrastructure, with new milestones in its AHCCCS MES modernization effort focused on data exchange and program integrity. AHCCCS also plans to roll out a new customer service system next month. The modernization effort is part of a broader initiative to replace legacy systems,...
For Arizona policymakers and Medicaid plans, the Office of Inspector General's Colorado findings highlight a growing tension between program oversight, the rapid expansion of private equity-backed applied behavior analysis (ABA) providers and the ability of families to access consistent therapy for children with autism.
The issue drew...
