1. 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!

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

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. AHCCCS Freedom To Work Unit
Where To Apply for FTW
AHCCCS Freedom To Work Unit
801 East Jefferson MD 1600
Phoenix AZ
Phone Number:
Fax Number: or

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 Part A Coverage
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, $ in 2010, $ 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)

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
Phone Number:
Fax Number: or

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?