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Cost Sharing

Cost Sharing . Background. State Legislature requires AHCCCS to pursue increased cost sharing Federal regulations allow mandatory cost sharing for people over 100% FPL Currently persons in the adult group have no copay requirement- either mandatory or non mandatory

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Cost Sharing

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  1. Cost Sharing

  2. Background • State Legislature requires AHCCCS to pursue increased cost sharing • Federal regulations allow mandatory cost sharing for people over 100% FPL • Currently persons in the adult group have no copay requirement- either mandatory or non mandatory • Currently, only TMA members are subject to mandatory copayments Reaching across Arizona to provide comprehensive quality health care for those in need

  3. “New” AHCCCS copayment rules became effective 1/1/14 • Rules repealed the mandatory copayments for Childless Adults • Rules added new copayment exemptions for all members for well visits and preventive services Reaching across Arizona to provide comprehensive quality health care for those in need

  4. Changes Planned for Fall 2014 • Mandatory, increased copays for new adult group for persons over 106% FPL to 133% FPL • Exploring: • Mandatory copays for members 18 and older • $8 copay for Non-Emergency Use of the Emergency Room (operational impacts) • Possible copay charge for inpatient stay • Increases to nominal copay amounts • Proposed rules – plan to post later part of summer Reaching across Arizona to provide comprehensive quality health care for those in need

  5. Questions? Reaching across Arizona to provide comprehensive quality health care for those in need

  6. Thank You. Reaching across Arizona to provide comprehensive quality health care for those in need

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