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AHCCCS Arizona Health Care Cost Containment System

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!.

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AHCCCS Arizona Health Care Cost Containment System

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  1. AHCCCSArizona 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!

  2. 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

  3. 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

  4. 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

  5. Freedom To Work Benefits • Net monthly earnings limit of 250% of the FPL ($2,270 in 2011) • Social Security Disability Income is NOT counted.

  6. Additional FTW Requirements • General Eligibility Requirements • Ineligible for regular AHCCCS • Financial Criteria • Age Range (16-64) • Willing to Pay a Premium

  7. FTW Eligibility Does Not Consider • Resources of applicant, spouse, or family • Unearned income of the applicant • Income of applicant’s spouse or family

  8. 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)

  9. 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

  10. 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.

  11. 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

  12. FTW Premiums Net Countable Monthly Income Premium $0 to $ 500.00 $0 $500.01 to $ 750.00 $10.00 $750.01 to $1000.00 $15.00 $1000.01 to $1250.00 $20.00 $1250.00 to $1500.00 $25.00 $1500.01 to $1750.00 $30.00 $1750.00 to $2257.00 $35.00

  13. 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)

  14. 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.)

  15. 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

  16. 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.

  17. 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.

  18. Medicare Cost Sharing (MCS) • Qualified Medicare Beneficiary (QMB) • AHCCCS Pays Premiums for Parts A and B • AHCCCS Pays Deductibles, Co-Insurance, and Co-Payments • 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

  19. 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

  20. 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.

  21. 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

  22. 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

  23. 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

  24. Questions?

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