Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.

How to apply for Medicaid

Medicaid is managed by individual states. Each state has different rules about eligibility and applying for Medicaid. Call your state Medicaid program (see below) to see if you qualify and learn how to apply.

Arizona Health Care Cost Containment System (AHCCCS, pronounced “access”) is Arizona’s Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services.

Contact information: General Information
AHCCCS
801 E Jefferson St
Phoenix, AZ 85034 Phone: 602-417-4000
In-State Toll Free: 1-800-654-8713 (Outside Maricopa County)
Out-of-State Toll Free: 1-800-523-0231  https://www.azahcccs.gov/

How Does AHCCCS work?

AHCCCS contracts with several health plans to provide covered services. In Arizona, an AHCCCS health plan works like a Health Maintenance Organization (HMO). The health plan works with doctors, hospitals, pharmacies, specialists, etc. to provide care. You will choose a health plan that covers your zip code area. If you are approved, you will choose a primary care doctor that works with that health plan. Your primary doctor will:

• Be the first person you go to for care
• Authorize your non-emergency medical services
• Send you to a specialist when needed

What Does it Cover?

AHCCCS health plans provide the following medical services:

• Doctor’s Visits
• Immunizations (shots)
• Prescriptions (Not covered if you have Medicare)
• Lab and X-rays
• Specialist Care
• Hospital Services
• Transportation to doctor
• Emergency Care

• Surgery Services
• Physical Exams
• Behavioral Health
• Dialysis

• Note: This is a partial list of covered services

What About Nursing Home Coverage?

Arizona Long Term Care (ALTCS) is the part of AHCCS that covers nursing homes and Long Term Care.

AHCCCS contracts with several program contractors to provide long term care services. In Arizona, an ALTCS program contractor works like a Health Maintenance Organization (HMO). The program contractor works with doctors, nursing homes, assisted living facilities, hospitals, pharmacies, specialists, etc. to provide care. You will also be assigned a case manager who will coordinate your care.

In addition to the services listed above, people who qualify for long term care can receive services such as:

• Nursing Facility
• Hospice
• Attendant Care
• Assisted Living Facility
• Adult Day Care Health Services
• Home Health Services, such as nursing services, home health aide, and therapy
• Home Delivered Meals
• Case Management

Note: This is a partial list of covered services

What is a Medicaid spend down?

Even if your income exceeds Medicaid income levels in your state, you may be eligible under Medicaid spend down rules. Under the “spend down” process, some states allow you to become eligible for Medicaid as “medically needy,” even if you have too much income to qualify. This process allows you to “spend down,” or subtract, your medical expenses from your income to become eligible for Medicaid.

To be eligible as “medically needy,” your measurable resources also have to be under the resource amount allowed in your state. Call your state Medicaid program to see if you qualify and learn how to apply.

Dual eligibility

Some people who are eligible for both Medicare and Medicaid are called “dual eligible’s.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (Part C). If you have Medicare and full Medicaid, you’ll get your Part D prescription drugs through Medicare, and you’ll automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D). Medicaid may still cover some drugs and other care that Medicare doesn’t cover.

Who pays my bills first—Medicaid or Medicare?

Medicaid never pays first for services covered by Medicare. It only pays after Medicare, employer group health plans, and/or Medicare Supplement (Medigap) Insurance have paid. Medicaid the last group to pay a claim, generally.