Arizona’s Reforms To Medicaid Granted By Feds

The Centers for Medicare and Medicaid Services (CMS) has approved most of Arizona’s request to reform its Medicaid program, known as the Arizona Health Care Cost Containment System (AHCCCS). Under the reformed program, eligible members will now make contributions to an account — similar to a Health Savings Account — to be used for services not currently covered by Medicaid, including dental, vision, weight loss and more.

Traditionally, Medicaid has served children, pregnant women, persons with disabilities and the elderly. T

Arizona’s waiver approval also includes an extension of existing authorities, such as mandatory managed care and use of home and community based services for members with long-term care needs, as well as a new $1,000 dental benefit for long term care members on ALTCS. These and other innovations have made the AHCCCS program one of the highest quality, most cost effective Medicaid programs nationally.

The new program includes:

•Health Savings Account. Adults over 100% of the Federal Poverty Level are required to pay a monthly premium at 2% of household income or $25, whichever is lesser.

•Giving Citizens Tools to Manage Their Own Health. Member premium contributions go into their AHCCCS CARE Account, which works like a flexible health savings account. These funds can be withdrawn by members and used for non-covered services, including dental, vision, chiropractic care, recognized weight loss programs, nutrition counseling, gym membership and sunscreen.

•Enforcing Member Contribution Requirements. Members will be disenrolled for failure to pay their monthly premium requirements.

•Engaging the Business and Philanthropic Community. Employers and charitable organizations can contribute funds into the AHCCCS CARE Account to support a healthy workforce and achieving health goals.

•Promoting Healthy Behaviors. The AHCCCS CARE program includes incentivizes to promote healthy behaviors. Members can defer their premium payments for 6 months if they meet healthy targets that include: (1) meeting preventive health targets like getting a wellness exam, flu shot, mammogram or cholesterol screening; or (2) managing chronic illnesses like diabetes, asthma or tobacco cessation. Meeting these healthy targets allows members to roll unused funds over into the next year and unlock funds in the AHCCCS CARE Account to be used for non-covered services.

•Supporting the Medical Home through Strategic Coinsurance. The AHCCCS CARE program uses a strategic coinsurance strategy that only assesses payment requirements retrospectively, so members are not denied services and providers are not burdened with uncompensated care and administrative hassle. Strategic coinsurance only applies to: (1) opioid use, (2) use of brand name drugs when a generic is available, (3) non-emergency use of the emergency department, and (4) seeing a specialist without a primary care provider’s referral.

•Connecting to Employment Opportunities. Through an innovative partnership with the Arizona Department of Economic Security, all AHCCCS CARE members will be automatically enrolled in job seeking programs.

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