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! AHCCCS Arizona Health Care Cost Containment System
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AHCCCS Freedom To Work and Medicare Cost Sharing Presented By David Cardinali Community Work Incentives Coordinator DIRECT Center for Independence, Inc.
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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!
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!
AHCCCSArizona Health Care Cost Containment System
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
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
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
Freedom To Work Benefits
Net monthly earnings limit of 250% of the FPL ($2,270 in 2011)
Determined Medically Eligible by a PAS(Pre-Admission Screening)
Determined Disabled by DDSA(Disability Determination Services Administration)
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
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.
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
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
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)
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.)
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
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.
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.
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
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
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.
Where To Apply for MCSAHCCCS - 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
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
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