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Customers or their representatives are required to report any changes that may affect their Medical Assistance (MA) eligibility, premium amount, or share of cost. The types of changes that must be reported are described in MA1502. However, anyone who knows about a change in the customer’s circumstances may report the change. Changes are most commonly reported by:
Customer;
Customer’s representative;
Customer’s spouse;
Customer’s relatives, friends or neighbors;
AHCCCS Complete Care (ACC) plan or ALTCS health plan;
Medical facilities and providers;
Attorneys; and
Trustees.
NOTE Information reported by someone other than the customer or the customer’s spouse or representative must be confirmed before any action can be taken. The customer or customer’s representative must confirm the change report is correct, or other proof must be received, even if the change would not normally need proof. For example, a neighbor reports that the customer moved out of state. This must be confirmed before taking any action as the neighbor may not have accurate information.
Changes can be reported:
Online through Health-e-Arizona Plus (HEAplus);
By phone;
By fax;
In writing; or
In person.
The customer is informed about their responsibility to report changes in a variety of ways, including:
On each approval letter or change letter;
On the AHCCCS Medical Assistance program application; or
Verbally during assistance with an in-person application or interview.
The processing of the change should be completed according to the timeframes below:
Unanticipated Change
The determination must be completed by the last day of the month 30 days after the report is received, unless a Request for Information (RFI) is sent. If an RFI is sent, the determination must be completed by the last day of the month 60 days after the change was received.
Anticipated Change
The determination must be completed by the last day of the month in which the change occurs unless the customer returns information less than 30 days prior to the end of the month in which the change occurs, then it must be completed by the end of the following month.
For unanticipated or anticipated changes, if the customer is found ineligible but considered for another category, processing must be completed within 45 days, or 90 days if disability‑based.
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Term |
Definition |
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Change in Circumstance |
Something that happens to a customer that may impact their Medicaid eligibility, enrollment, share of cost, or premium amount, or ability to be contacted or receive mail. |
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Report |
A notification provided to the Agency that informs the Agency that a change in circumstance has occurred or will occur. |
The type of proof needed depends on the type of change. See MA1502 for types of changes and proof needed.
In general, changes must be reported as soon as the future event becomes known. However, there are different timeframes for some changes. See MA1502 for types of changes and timeframe requirements.
NOTE Special reporting requirements apply to trustees of Special Treatment Trusts. Trustee reporting requirements are described in MA803.A.
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Program |
Legal Authorities |
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All programs, except KidsCare |
42 CFR 435.919(b)(2) and 42 CFR 435.912(c)(5)-(6) |
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ALTCS |
AAC R9-28-411(A) |
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SSI MAO |
AAC R9-22-1501(H) |
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MSP |
AAC R9-29-224 |
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FTW |
AAC R9-22-1905 and R9-28-1305 |
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BCCTP |
AAC R9-22-2005(D) |
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KidsCare |
42 CFR 457.343 AAC R9-31-308 |