Medicaid Costs and Coverage in Arizona

How much is Medicaid in Arizona? To understand Medicaid cost estimates in AZ, potential applicants must understand that the state healthcare system is divided into several Medicaid sub-programs with different eligibility requirements, copayment costs and benefits coverage. How much does Medicaid cost for each Arizona state Medicaid sub-program?The Arizona Health Care Cost Containment System (AHCCCS) determines costs for all state Medicaid programs. What services are covered by Medicaid in Arizona is also determined according to federal guidelines by the AHCCCS and the three state departments which oversee it: The Department of Economic Security (DES), The Department of Child Safety and The Social Security Administration (SSA).All types of Medicaid insurance in Arizona include coverage for essential medical services, like emergency care. Medicaid coverage for all claimants is dependent on paying necessary copayments and continuing to follow applicable benefits eligibility criteria. Keep reading for answers to many of the most frequently asked questions about Medicaid costs and coverage in Arizona.

How much is Medicaid in Arizona?

How much Medicaid costs in Arizona depends on the the medical procedure and the category of benefits recipient. AZ Medicaid cost estimates generally refer to a recipient’s copayment costs, or the amount that a healthcare provider can request from the Medicaid recipient for services rendered. Some Arizona residents, such as otherwise ineligible adults and Transitional Medical Assistance (TMA) program participants, have Medicaid coverage with mandatory or required copayments that allow a provider to deny medical service if the Medicaid recipient fails to pay the copayment. Other Arizona Medicaid program coverage includes optional or nominal copayments that, although requested by the provider, cannot be used as a reason to deny service to a patient in need. Patients that fall into one of the following Medicaid benefits categories must pay some amount for most medical services:

  • AHCCCS for Families with Children
  • Young Adult Transitional Insurance (YATI) for young adults in foster care
  • State Adoption Assistance for Special Needs Children who are being adopted
  • Freedom to Work for disabled working adults (FTW)
  • Supplemental Security Income (SSI) or SSI Medical Assistance Only (SSI MAO) for the elderly, blind and disabled

Complete Medicaid coverage options with no mandatory or nominal copayment fees are also provided to some benefits recipients who may not participate in the abovementioned programs. These include most children under the age of 19, claimants suffering from a serious mental illness, recipients who require long term care or serious rehabilitation services, pregnant undergoing the Medicaid application process, women enrolled in the Breast and Cervical Cancer program and more. In addition, some medical services do not require a copayment no matter what type of Medicaid insurance a benefits recipient possesses. Complete Medicaid insurance coverage is provided to all Medicaid recipients for emergency care, family planning services and supplies, pregnancy related healthcare and preventive services such as basic check-ups, immunizations, pap smears, mammograms and colonoscopies.

What Services Are Covered by Medicaid in Arizona?

Medicaid coverage in Arizona includes all medical services and healthcare options as required by the federal government along with some additional healthcare options provided by the state. Some types of coverage offer more comprehensive coverage than others. Here are some examples of the medical programs in the state of Arizona for different groups of Medicaid recipients:

Medicaid Coverage in Arizona for General Healthcare Services

  • Physician services: physician services that are covered by Medicaid include doctor’s visits, specialist care, physical exams, surgery, immunizations and more.
  • Prescriptions: includes most necessary prescription drugs, sometimes with a small copayment.
  • Hospital Services: required emergency care whether in-state or out of state. Hospital services ordered by the doctor like laboratory results, x-rats and CT scans Lab and X-rays are also covered.
  • Behavioral Health: Arizona provides Medicaid coverage for benefits recipients suffering from behavioral health issues related to mental illness or substance abuse issues.

Arizona Medicaid Coverage for Women, Children and Family Services

  • Maternity Services: Medicaid cost estimates are zero for maternity services before, during and after the pregnancy.
  • Family Planning Services: All types of Medicaid insurance in Arizona cover family planning services for all members of an eligible household
  • Services for Children and Adults under the age of 21: Medicaid coverage for benefits recipients under 21 includes Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services, dental screening, care and emergency treatment and searing and vision exams including hearing aids or glasses as needed.

Download our comprehensive guide for more details on Medicaid’s covered services.

Medicaid Coverage for Participants in the Arizona Long Term Care (ALTCS) Program

The ALTCS Medicaid program offers more extensive Medicaid coverage than many other programs and follows different income requirements for eligibility. The ALTCS program is managed differently than other types of programs in Arizona and covers several additional medical services like:

  • Nursing home, assisted care facility or hospice care costs
  • Costs associated with in-home nurse, care attendant or adult day care
  • Home Health Services such as therapy and delivered meals
  • Case management
  • Dental services

What Medical Services Does Medicaid Not Cover in Arizona?

Some medical services are not covered by Medicaid in Arizona, most often those seen as voluntary or done without the recommendation of a doctor. Applicants or benefit recipients who are unsure what is included in their Medicaid coverage should contact an AHCCCS representative before receiving the medical service to avoid any payment issues. Along the same lines, certain medications are usually barred from receiving coverage in Arizona, such as drugs used for weight loss, fertility promotion, hair growth, non-prescription vitamins or cough syrup, barbiturates, benzodiazepines and more. Doctors working with Medicaid recipients should be aware of what is not covered and which treatments are covered in Arizona.

For more details on the costs and coverage of Medicaid benefits, download our comprehensive guide.