1101 Enrollment Overview

Revised 05/20/2025

Policy

Customers who qualify for AHCCCS Medical Assistance are enrolled with an AHCCCS Complete Care (ACC) plan, an ALTCS Program Contractor or a fee-for-service plan.

 

Enrollment Rights

The customer may file a grievance for an adverse action related to enrollment or provision of services taken by a health plan, a program contractor or AHCCCS.  See MA1710 - Grievances for more information.

 

Enrollment Rosters

Each contractor receives enrollment files from AHCCCS. Daily and monthly enrollment files are produced. The availability of enrollment files to the contractor is considered legal notification of the contractor’s responsibility for providing care to customers.

Daily enrollment files include:

• New members for whom the contractor is responsible;

• Persons for whom the contractor is no longer responsible, including persons who are:

  • Newly disenrolled; or

  • Deceased; or

  • Incarcerated

• Changes to customers’ demographic data, like name, address or date of birth;

• Rate codes; and

• Share of cost information.

 

Monthly enrollment files are produced three days prior to the end of the month for each contractor. They identify the total active population for each contractor as of the first of the next month.

Definitions

Term	Definition
AHCCCS Complete Care (ACC) plan	An entity with a prepaid capitated contract with AHCCCS to provide acute care medical services to AHCCCS customers.
Arizona Long Term Care System (ALTCS) Program Contractor	A contracted managed care organization that provides long term care, acute care, behavioral health, and case management services to eligible customers who are determined to need an institutional level of care.
Fee-For-Service (FFS)	Means AHCCCS pays providers directly for covered services provided to the customer, instead of the payment being made through a contracted health plan.

 

Legal Authorities

This requirement applies to the following programs:

Program	Legal Authorities
ALTCS and FTW-ALTCS	AAC R9-28-412 through R9-28-418
All programs except ALTCS and FTW-ALTCS	AAC R9-22-1701 through R9-22-1705