Current Status

Arizona’s legislation SB 1092 requires the state to submit an amendment to the underlying waiver each year, requesting work requirements, a time limit on program eligibility and other harmful elements. State waiver requests under that legislation had been denied by CMS during the Obama administration. However, in January 2019, CMS approved the request to add a work requirement, eliminate retroactive eligibility, and add premiums for enrollees over 100% of poverty. CMS explicitly denied the requests to impose a time limit on Medicaid eligibility and to provide financial assistance to design and implement the work requirement program.

Waiver History

The entire Arizona program is run through an 1115 waiver, and the state adopted a “traditional” Medicaid expansion January 1, 2014. On October 1, 2016 the state added a number of non-traditional elements to their program through an amendment of the underlying waiver that is approved through September 2021.

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Population Covered

The AHCCCS CARE program covers childless adults in the Medicaid expansion population (19-64) between 100 and 138 percent of the federal poverty level, or about $12,000 to $16,000 per year for a single person. Those below 100 percent of poverty may choose to opt into the program.

Components 

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Premiums

Enrollees are subject to premiums in the form of health savings account contributions of $25 or two percent of income per month, whichever is less. Those who fail to pay their premiums within a two month grace period are dis-enrolled form the program, but may reenroll at any time. Individuals may also apply for a hardship exemption from premiums at any time. Enrollees who meet any “Health Arizona” wellness program target (see detail below) is exempted from premium payments for six months. Learn more and get advocacy strategies to combat premiums.

Cost-Sharing

The AHCCCS CARE program charges enrollees “strategic” cost sharing which is designed to drive individuals towards higher value care. For example, enrollees are charged $4 for a brand name drug when a generic is available, and $0 for a generic medication. All cost-sharing is applied retrospectively rather than at point of service, and members receive a quarterly co-payment invoice. All cost-sharing amounts fall within the standard Medicaid “nominal” cost sharing range, and my not exceed 3 percent of a beneficiaries quarterly income. Learn more and get advocacy strategies to combat cost sharing.

Health Savings Accounts

The “CARE” health savings account is funded through monthly premiums, although third parties like charitable organizations may also contribute. CARE account money may be used like a flexible spending account on approved health care related goods and services. In order to unlock the CARE account, enrollees must be current in their premium contributions and perform at least one “Healthy Arizona” health behavior (see detail below.) Enrollees who make timely premium payments and participate in the Health Arizona program can roll over unused funds from year to year. Learn more and get advocacy strategies to combat HSAs.

Wellness Program

The Healthy Arizona program is linked to enrollees’ health savings account, and allows them to access funds in the account. Healthy Arizona is a set of health targets including certain preventative health measures—like flu shots or mammograms-- and chronic disease management tools. Enrollees must reach at least one target per year to access funds in their health savings account, and are exempted from premiums for six months for meeting one or more targets. Learn more and get advocacy strategies to combat wellness programs.

Employment/Job Search Program

The state was approved for a voluntary work referral, search and support program. The employment program is not linked to member eligibility or enrollment.