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Disenrollment due to loss of eligibility is effective with the end of the month prior to the effective date of discontinuance with the following exceptions:
Death;
Voluntary discontinuance;
Discontinuance due to a hearing decision; and
Incarceration.
Disenrollment due to death is effective on the date of death.
Disenrollment based on a request for voluntary discontinuance by the customer or the customer’s representative is effective on the last day of the month prior to the effective date of discontinuance.
Exception: If the customer or representative requests an immediate voluntary discontinuance, disenrollment is effective the day after the date the discontinuance is received by PMMIS.
When benefits have been continued pending an eligibility appeal decision and the discontinuance is upheld, disenrollment is effective the date the discontinuance (based on the hearing decision) is received by PMMIS.
When a customer is detained and incarcerated, the customer should not be disenrolled when all other eligibility requirements are met, enrollment is changed to a no pay status.
When the customer’s ALTCS is ending, but he or she is still eligible for an acute care program, see How to Pre-enroll a Customer in an AHCCCS Complete Care (ACC) Plan for instructions.
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Term |
Definition |
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Voluntary Withdrawal |
Disenrollment based on a request for voluntary discontinuance by the customer or the customer’s representative. |
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Eligibility Hearing |
The eligibility hearing is an administrative process. It is designed to ensure a fair and impartial review of an adverse action that is appealed. |
This requirement applies to the following program:
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Program |
Legal Authorities |
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All Programs |
AAC R9-22-1705(C) AAC R9-28-418 (ALTCS) |