2012 Health Manual English - Children's Action Alliance

155 Pages·2014·1.3 MB·English

Health Care Resources for Arizona’s Low
Income and Uninsured Families

June 2014 Edition

Produced by and distributed by: With the financial support of:
Health Care Resources for
Arizona’s Low Income and Uninsured Families
Produced and distributed by

Funding for this manual was made possible by a grant from

Children’s Action Alliance is a non-profit, non-partisan organization dedicated to
promoting the well-being of all of Arizona’s children and their families through research,
policy development, media campaigns and advocacy.

Children’s Action Alliance
4001 N. 3rd Street, Suite 160
Phoenix, AZ 85012
Phone: [phone]
Fax: [phone]

CAA Southern Arizona
33 S. 5th Ave.
Tucson, AZ 85701-1800
Phone: [phone]

www.azchildren.org
Electronic Document Navigation: To conveniently navigate the electronic version of this
document, click on the topics below to link directly to the complete section within the document.

Table of Contents
I. Overview .................................................................................................................... 5
II. Health Insurance Marketplace ................................................................................ 6

III.AHCCCS Programs ................................................................................................ 10

a. Characteristics of Arizonans Who May Be Eligible for Medicaid ......................... 11

b. AHCCCS Acute Services ....................................................................................... 12

c. Arizona Long Term Care System (ALTCS) Services ............................................ 12

d. Who Decides AHCCCS Eligibility? ....................................................................... 13

Social Security Administration ........................................................................... 13

Arizona Department of Economic Security (DES) ........................................... 13

AHCCCS Administration ................................................................................... 13

e. Eligibility Requirements ............................................................................................ 14

f. What Does AHCCCS Health Insurance Cost? ........................................................... 14

g. How Does an AHCCCS Health Plan Work? ............................................................. 15

h. Choosing an AHCCCS Health Plan .......................................................................... 16

i. Choosing a Primary Doctor ........................................................................................ 18

j. Grievance and Appeal Process ................................................................................... 18

k. Programs by Covered Group ..................................................................................... 21

l. AHCCCS Programs .................................................................................................... 22

m. How to Order AHCCCS Applications ..................................................................... 40

n. AHCCCS Contact Information .................................................................................. 40

o. AHCCCS Enrollment Assistance .............................................................................. 41

IV. The Arizona Department of Economic Security (DES) ....................................... 46

a. General Information ................................................................................................ 46

b. DES Family Assistance Offices .............................................................................. 47

V. Behavioral Health Resources ................................................................................. 49

a. What are Behavioral Health Services? ................................................................... 49

b. Maricopa County Emergency Services ................................................................... 49

c. Regional Behavioral Health Authorities (RBHAs)................................................. 50

d. Tribal RBHAs ......................................................................................................... 51

e. Community Based Agencies/Community Crisis Numbers..................................... 51

f. Support Groups ....................................................................................................... 52

VI. Community Health Centers ................................................................................... 56

a. What is Primary Care? ............................................................................................ 56

b. General Information About CHCs .......................................................................... 56

c. Community Health Center Locations ..................................................................... 58

VII. Dental Health ...................................................................................................... 63

a. Arizona Dental Association .................................................................................... 63

b. Arizona Dental Sealant Program ............................................................................ 64

c. Arizona School-Based Fluoride Mouthrinse Program ............................................ 64
d. Arizona Fluoride Varnish Program ......................................................................... 64
e. Other Organizations ................................................................................................ 65

f. Dental Treatment Referral List ............................................................................... 66

VIII. Native American Health Resources .................................................................. 72

a. General Information ................................................................................................ 72

b. American Indian Health Program (formerly “Indian Health Service”) .................. 72

c. Questions and Answers ........................................................................................... 72

IX. Services For Children With Special Needs ........................................................... 74

a. What are Special Needs? ........................................................................................ 74

b. Arizona Department of Education (ADE) Services ................................................ 74

c. Children's Rehabilitative Services .......................................................................... 75

d. Arizona Early Intervention Program, Division of Developmental Disabilities, and

Arizona Long Term Care System .......................................................................... 75

e. Other Department of Health Services Programs ..................................................... 82

f. Social Security Benefits .......................................................................................... 82

g. Children in Foster Care/Comprehensive Medical and Dental Program ................. 82

h. Other Resources ...................................................................................................... 83

X. Small Business/Employer Health Resources ........................................................ 86

a. Small Business Health Options Program (SHOP) .................................................. 86

b. Arizona Small Business Association ...................................................................... 86

XI. Youth And Young Adults ....................................................................................... 89

a. Young Adult Transitional Insurance ....................................................................... 89

b. AHCCCS Care ........................................................................................................ 89

c. Continuing Education and Training ........................................................................ 89

Jobs Corps 89

Maricopa Community Colleges .......................................................................... 90

Other Community Colleges in Arizona: ............................................................ 91

d. Other Services for Youth ........................................................................................ 91

XII. Other Community Health Resources ................................................................ 94

a. Arizona Department of Health Services and County Health Departments ............. 94

Health Start .......................................................................................................... 96

Women, Infants, and Children (WIC) ............................................................... 96

b. A to Z Child Health Links ...................................................................................... 97

c. Prenatal Care ........................................................................................................... 97

South Phoenix Healthy Start .......................................................................................... 97

d. Birth to Five Helpline ............................................................................................. 98

e. Centers for Independent Living (Arizona Statewide Independent Living Council)98

f. Child Care Resource and Referral .......................................................................... 99

g. Child Protective Services ........................................................................................ 99

h. Maternal, Infant and Early Childhood Home Visiting Programs ......................... 100

i. Community Information and Referral .................................................................. 101

j. Domestic Violence ................................................................................................ 101
k. Family Planning .................................................................................................... 101
l. Nutrition Assistance (formerly the Food Stamp Program) and Food Banks ........ 104

m. Head Start.............................................................................................................. 105

n. Homeless Services ................................................................................................ 106

o. Immunizations....................................................................................................... 117

p. Flu Clinics ............................................................................................................. 118

q. Legal Aid .............................................................................................................. 118

r. Gay, Lesbian, Bisexual, Transgender Resources .................................................. 120

s. Medical Services Project....................................................................................... 121

t. Medical Networks - Discounted Health Services ................................................. 122

Pima Community Access Program (PCAP) .................................................... 123

Community Access Programs of Arizona- Mexico (CAPAZ-MEX) ............. 123

Santa Cruz Health Connection ......................................................................... 124

u. Prescription Drug Discount Programs .................................................................. 124

v. School-Based Health Centers ............................................................................... 125

w. Sexually Transmitted Diseases ............................................................................. 125

x. Social Security Administration ............................................................................. 129

y. Spanish-English Hotline ....................................................................................... 129

z. Substance Abuse ................................................................................................... 130

aa. Unemployment ...................................................................................................... 130

bb. Veterans’ Services ................................................................................................ 131

cc. Vision Benefits and Services ................................................................................ 133

dd. Neighborhood Christian Clinic ............................................................................. 133

ee. Neighborhood Outreach Access to Health (NOAH) ............................................ 133

ff. Prescription Drug Benefit – CoppeRx® ............................................................... 134

gg. Prescription Drug Benefit – Coast2CoastRx ........................................................ 134

hh. Pre-existing Condition Insurance Plan (PCIP) ..................................................... 134

ii. Mission of Mercy .................................................................................................. 135

jj. HIV/AIDS ............................................................................................................. 135

kk. Crews’n Healthmobile .......................................................................................... 138

XIII. Tools ................................................................................................................... 141

a. AHCCCS Income Eligibility Limits ..................................................................... 141

b. AHCCCS Program Eligibility............................................................................... 142

c. How to Apply for AHCCCS Programs ................................................................. 146

Federally Qualified Health Centers Facilitating Health-e-Arizona

Applications ........................................................................................................ 147
d. Tips for Completing Your AHCCCS Application ................................................ 148

e. How to Renew your AHCCCS Coverage ............................................................. 150

f. How AHCCCS Health Plans Work ...................................................................... 150

g. Citizenship Requirements ..................................................................................... 151
I.
Healthcare for
Adults and
Children: Health
Insurance
Marketplace &
AHCCCS

http://www.azahcccs.gov
http://www.healthcare.gov
I. Overview

This manual provides detailed information about how families can access health care coverage
and other benefits through AHCCCS (Arizona’s Medicaid agency) and the health insurance
Marketplace. A family’s income will determine whether they qualify for an AHCCCS medical
programs or subsidies to lower the cost of a health insurance plan purchased through the Health
Insurance Marketplace.

There are many different health coverage programs within AHCCCS and each will have its own
income requirements. Filling out an AHCCCS application will determine which program an
applicant is qualified for. Due to the Affordable Care Act, AHCCCS health plans have expanded
coverage to higher income levels than in the past.

Families who earn too much to qualify for Medicaid may still receive financial assistance to
purchase a health plan on the Marketplace. Anyone who does not qualify for an AHCCCS
health plan can apply for a health plan on the Marketplace, but whether they qualify for financial
benefits will depend on the family’s income, employment benefits, and residency status.

AHCCCS and the Marketplace use different application systems. The application system used
by AHCCCS is also used to apply for many other public benefits such as nutrition assistance,
and each program has its own requirements. The Marketplace application system can only be
used to apply for health insurance.

Income requirements for various AHCCCS programs are discussed in this manual in the sections
that follow and are also included in the tools section of this resource manual. The guideline for
determining whether a family’s income qualifies them for AHCCCS programs or subsidized
Marketplace plans is referred to as the Federal Poverty Level (FPL).

To determine where to apply first, applicants can be screened by comparing their estimated
family income to the income requirements for AHCCCS programs. If the applicant’s estimated
income is below 150% of the FPL, then they should consider starting with the AHCCCS
application. The table below can be used as a preliminary screening tool on whether to start with
AHCCCS or the Marketplace. It is important to note that there are many AHCCCS programs
with separate income requirements and it is worth contacting an application assister to consider
options by dialing 211.

Family If family income is LESS 150% of FPL If family income is
size than 150% of FPL OVER 150% of FPL
1 $17,505
2 Consider starting a $23,595 Consider starting a
3 AHCCCS application $29,685 Marketplace application
4 (Information on page 10) $35,775 (Information on page 6)
5 $41,865
For families over 5 persons, add $6090 for each additional person
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A 2014 FPL chart is located in the tools section of this resource manual. Please see
http://aspe.hhs.gov/poverty/ for the most current guidelines. The FPL is updated by the federal
government every year and varies by family size.

II. Health Insurance Marketplace

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama
in March of 2010. Millions of Americans have already benefitted from many of
the law’s provisions including coverage for preventive health services, ban on lifetime limits,
and insurance coverage for young adults. On October 1, 2013 the Health Insurance Marketplace
opened to enrollment. Arizona has elected to have the Federal Government operate the
Marketplace for Arizona, which means that Arizonans can apply for coverage through the
federally run website, www.healthcare.gov.

The Marketplace is a new way to find quality health coverage for those who have no coverage
now or who are looking at other options. With one Marketplace application, you can learn if you
can get lower healthcare insurance costs based on your income, compare your coverage options
side-by-side, and enroll. Tax credits to offset premiums and cost-sharing reductions that reduce
out-of-pocket health costs are available based on income.

Categories of Marketplace Insurance Plans

There are five categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and
Catastrophic. All Marketplace insurance plan categories offer the same set of essential health
benefits. The categories do not reflect the quality or amount of care the plans provide. The
category you choose affects how much your premium costs each month and what portion of the
bill you pay for things like hospital visits or prescription medications. It also affects your
total out-of-pocket costs —the maximum amount you’ll spend for the year if you need lots of
care.

When choosing your health plan, pay close attention to both the cost of the premium and the cost
sharing details included in each plan and how it will relate to your health needs. Cost sharing
includes health costs incurred through copayments, deductibles, and coinsurance. A plan with
cheap monthly premiums may save you from paying a higher premium, but may actually result
in higher overall costs when you access health care. It is important to look at the cost-sharing
included in each plan when deciding which plan will best fit your health needs. Note that only
plans purchased at the Silver level or above will qualify for tax credits to offset premium costs;
and cost-sharing reductions only apply to Silver level plans.

In addition to the premium and cost sharing details in each plan, make sure you check with the
health insurance plan to see whether the providers that are under the plan meet your health needs.
If you visit providers that are not covered under the plan, you may encounter significant health
costs. Links to each plan are listed in the Qualified Health Plans section.

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Essential Health Benefits Package

All Marketplace plans are required to provide essential health benefits. The essential health
benefit benchmark for Arizona is the State employee plan. Complete details are provided here,
http://www.cms.gov/cciio/resources/data-resources/ehb.html - review.

In general the ACA requires an essential health benefits package in every health plan to include
services and items in these 10 broad categories of care:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care*

*Not all plans on the Marketplace include dental coverage for kids. This is because there are
also separate, stand alone dental plans available for purchase. Stand alone plans do not qualify
for premium tax credits.

How to Apply to the Health Insurance Marketplace and AHCCCS?

There are several ways to apply for health insurance using the Marketplace. You can go directly
to www.healthcare.gov to learn more about the Marketplace and to apply for coverage. You can
also receive assistance from a Navigator or an Assister, trained individuals available in the
community to help you in completing the required application.

Normally, you can only apply for the Marketplace during a certain time frame of the year known
as Open enrollment. Open enrollment for the Health Insurance Marketplace begins November
15th and continues until February 15th. After the February 15th deadline, most applications will
no longer be accepted; however, special circumstances such as the loss of a job, divorce,
relocation, and other situations will allow you to apply. A list of these special circumstances is
available at
https://www.healthcare.gov/screener/marketplace.html?state=Arizona&path=marketplace

Several plans on the Marketplace can be purchased outside of healthcare.gov directly from the
health plan, but consumers should be advised that these plans will not be qualified for any tax
credits or cost sharing reductions.

The Health-e-Arizona Plus application at www.healthearizonaplus.gov serves as the application
portal for the full range of AHCCCS benefits and local health programs, Nutrition Assistance
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(Food Stamps) and Cash Assistance benefits. You can apply for AHCCCS at any time of the
year.

Navigators and Assisters

Several Arizona organizations received grant funds from the Federal government to help provide
outreach and enrollment assistance for the Marketplace. These organizations can be reached by
dialing the state wide hotline 211. Personnel are trained to provide assistance and are
strategically located throughout the state under the direction of the following organizations:

• Greater Phoenix Urban League, Inc. 602-254-5611
• Arizona Alliance for Community Health Centers 602-253-0090
• Arizona Board of Regents, University of Arizona 520-292-6900 or 520-512-0144
• Campesinos Sin Fonteras, Inc 928-627-5995

Each of these organizations partner with many other local organizations to coordinate outreach
opportunities throughout Arizona. A map to locate a site nearby is located at
http://coveraz.org/navigators-and-assisters-map/

Consumers can also call 211 for statewide referral to a Navigator near the zip code they reside in.

Direct access to the Marketplace application is at healthcare.gov or by calling 1-800-318-2596.

Qualified Health Plans Offered on the Marketplace

Health plans that are officially registered with the Marketplace are also known as Qualified
Health Plans. Overall, Arizonans have nearly 1,200 options available statewide. Every year,
health insurers will review the plans offered on the Marketplace and consider changes. Listed
below are the names of the qualified health plans with details of the plans offered and links to
additional information. Consumers can also go to healthcare.gov to look at the plans in their
county.

After purchasing a plan on the Marketplace, the consumer must pay the monthly premium to
begin coverage. If you purchased a plan before the 15th of the month, then your coverage can
begin as early as the 1st of the following month. If you purchased a plan after the 15th, then your
plan will begin the month after the next month.

Other sites are available to search qualified plan information by state and region. They include:

• ValuePenguin: http://www.valuepenguin.com/
• Cover Arizona: http://coveraz.org/health-plan-information/ (Links to health plan formularies
and provider networks are available and posted on this page also.)

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