AHCCCS
Arizona Health Care Cost Containment System
AHCCCS Freedom To Work
and Medicare Cost Sharing
Presented By
David Cardinali
Community Work Incentives Coordinator
DIRECT Center for Independence, Inc.
Thank you to Magellan for the use of their presentation!
Medicaid Coverage in Arizona
AZ’s Medicaid program is called the
Arizona Health Care Cost Containment
System, or AHCCCS

To qualify for regular AHCCCS a single
individual cannot have income that
exceeds 100% of the 2011 Federal
Poverty Level, or $908
Programs With Additional
Eligibility Requirements
Freedom To Work (FTW) • Medicaid buy-In for the disabled

Medicare Cost Sharing (MCS) • Help pay for some Medicare
premiums, co-pays & deductibles
Freedom To Work (FTW)
Provides Medicaid services to
qualified individuals with disabilities
who are employed.
Eligibility for Freedom to Work is
determined by the AHCCCS
Freedom to Work Unit
Freedom To Work Benefits

Net monthly earnings limit of 250% of
the FPL ($2,270 in 2011)

Social Security Disability Income is NOT
counted.
Additional FTW Requirements

General Eligibility Requirements

Ineligible for regular AHCCCS

Financial Criteria

Age Range (16-64)

Willing to Pay a Premium
FTW Eligibility Does Not Consider

Resources of applicant, spouse, or
family

Unearned income of the applicant

Income of applicant’s spouse or family
FTW Basic Coverage
Disabled

Receiving Social Security Disability

Determined Medically Eligible by a PAS
(Pre-Admission Screening)

Determined Disabled by DDSA
(Disability Determination Services Administration)
FTW Basic Coverage Groups
Employed

Working Full or Part Time (at least 40 hours
per month)

Paid at least minimum wage for working

Paying Social Security and Medicare taxes on
earnings
NOTE: This also applies for self-employed
FTW Six Month Guarantee
The customer is guaranteed six months
of AHCCCS coverage the first time he or
she is approved for AHCCCS Medical
Services.
NOTE: There are some exceptions to
the 6 month guarantee.
FTW Six Month Guarantee
Exceptions







Fails to pay the FTW premium
Moves out-of-state
Dies
Voluntarily withdraws from AHCCCS program
Is an inmate of a public institution
Was factually ineligible when initially enrolled
with the health plan
Is adopted
FTW Premiums
Net Countable Monthly Income
Premium
$0
$500.01
$750.01
$1000.01
$1250.00
$1500.01
$1750.00
$0
$10.00
$15.00
$20.00
$25.00
$30.00
$35.00
to
to
to
to
to
to
to
$ 500.00
$ 750.00
$1000.00
$1250.00
$1500.00
$1750.00
$2257.00
Eligibility Reviews



Renewals completed every 12 months
Failure to provide requested information
can result in loss of AHCCCS coverage
A re-evaluation of SMI diagnosis is
required every 12 months (must include
current psychiatric notes)
FTW Unit

A customer 16 – 64 years of age who meets
the non-financial criteria, is employed, and fails
to meet the financial income limits for other
Medicaid programs, will be referred to the
Freedom to Work Unit.

The customer will be sent a notice to inform
him or her of this process. (Similar to SSA’s
disability determination process.)
Where To Apply for FTW
AHCCCS Freedom To Work Unit
801 East Jefferson MD 1600
Phoenix AZ 85034
Phone Number: 602-417-6677
Fax Number: 602-417-6675
www.azahcccs.gov or
www.healtheariona.org
Medicare



Statutory provision of Title XVIII of the Social
Security Act that provides hospitalization and
medical insurance to persons who are aged,
blind, or disabled.
The recipient pays part of the insurance and
the federal government subsidizes.
Medicare Part A, Part B, and Part D.
Medicare Coverage

Medicare Part A Coverage
• Most individuals do not pay a premium based
on FICA deductions from wages.

Medicare Part B Coverage
• Monthly premium ($96.40 in 2009, $110.50 in
2010, $115.40 in 2011 & $99.90 in 2012).

Medicare Part D Coverage
• Prescription drug plan through Medicare.
• Medicaid customer’s get their prescription
drugs through a Medicare drug plan.
Medicare Cost Sharing (MCS)



Qualified Medicare Beneficiary (QMB)
•
•
AHCCCS Pays Premiums for Parts A and B
AHCCCS Pays Deductibles, Co-Insurance, and CoPayments
Specified Low-Income Medicare Beneficiary (SLMB)
•
•
Receives Medicare Part A
AHCCCS Pays Premium for Part B
Qualified Individual 1 (QI-1)
•
AHCCCS Pays Premium for Part B
Medicare Cost Sharing Approval
It may take up to 90 days before:
●
Social Security Administration stops
deducting the premium amount from the
applicants monthly check
●
AHCCCS starts to pay the premiums
Medicare Buy In

There is no automatic Medicare buy-in under
the AHCCCS Freedom to Work program

Customers who are approved for AHCCCS
Freedom to Work will continue to be
responsible for payment of their Medicare
premiums.

Freedom to Work customers can also apply for
MCS.
Where To Apply for MCS
AHCCCS - SSIMAO Office
801East Jefferson MD 3800
Phoenix AZ 85034
Phone Number: 602-417-5010
Fax Number: 602-258-4619
www.azahcccs.gov or
www.healtheariona.org
Application Processing

AHCCCS Central Screening Unit
• Reviews the application
• Reviews supporting
•
•
•
•
•
•
documentation/verifications
Send a Request for Information as needed
Determine eligibility for SSI MAO or MCS
Send a decision notice
Refer application if needed
Complete eligibility reviews (renewals)
Process applications within 45 days
Thanks to our presenters:






Daniel Chavez, District Manager, South Tucson
SSA Office
Ricardo Chavez, Professional Relations Officer,
Disability Determination Services
Dan Frey, Office of Congresswoman Gabrielle
Giffords, Constituent Services Rep.
Alicia Morado, Southern Arizona Legal Aid
Linda Fischer, Arizona Center for Disability Law
Dave Cardinali, CWIC, DIRECT Center for
Independence
Questions?