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A FTW premium is calculated for all customers who qualify for:
AHCCCS Medical Services under an AHCCCS FTW coverage group; or
FTW-ALTCS services and do not have a Share of Cost (SOC).
The FTW premium amount is based on the customer’s net countable monthly earned income:
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From |
To |
Premium |
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$0.00 |
$500.00 |
$0 |
|
$500.01 |
$750.00 |
$10 |
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$750.01 |
$1,000.00 |
$15 |
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$1,000.01 |
$1,250.00 |
$20 |
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$1,250.01 |
$1,500.00 |
$25 |
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$1,500.01 |
$1,750.00 |
$30 |
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$1,750.01 |
The FTW income limit (250% FPL) |
$35 |
Exception:
American Indian and Alaska Native customers, as well as the children and grandchildren of tribal members, are not charged a premium when they prove their tribal enrollment (or that of their parent/grandparent).
American Indians and Alaska Natives who qualify for FTW must provide proof of tribal enrollment to be exempt from monthly premium charges. Proof of enrollment or tribal membership includes:
Certificate of Degree of Indian Blood;
Tribal ID;
Tribal Census Record;
Documents issued by a federally recognized Indian Tribe or the Bureau of Indian Affair
Payment record from a Tribal Benefit Program;
Enrollment/membership card with the tribal seal and/or official signature;
Tribal Voter Registration card; and
Letter on tribal letterhead with an official signature confirming membership, descendancy, or affiliation with the Tribe
Documents with the person’s name that show affiliation with a federally recognized Indian Tribe:
Tribal Gaming Payment Statements,
Documents showing receipt of assistance payments from a Tribe, including General Assistance and Tribal Foster Care/Adoption Subsidy,
Letter from the Marketplace granting a tribal exemption based on tribal membership of Alaskan Native shareholder status,
Documentation of tribal land parcel allocation,
Documents issued by the Indian Health Service (HIS), 638 or UIO showing individual is eligible for services as an American Indian/Alaskan Native
Documents for certain family members of an enrolled tribal member
Documents from the list above for the enrolled member of a federally recognized tribe, plus proof of relationship to the enrolled tribal member for the family members listed below:
Spouses (if eligible for services by resolution of the Indian Tribe or tribal organization):
Marriage certificate or court document identifying current legal marriage
Individual pregnant with the child of a member of an Indian Tribe or shareholder of an Alaska Native corporation:
Marriage certificate or written acknowledgement of paternity
Child or grandchild of an enrolled member of an Indian Tribe or shareholder of an Alaska Native corporation:
Birth certificate,
Court documents,
Record of baptism, or
Other official records showing relationship to the enrolled member
When a person claiming to be an American Indian, Alaska Native, or the child/grandchild of a tribal member does not provide proof of tribal enrollment, the premium exemption does not apply and a premium may be charged.
NOTE Do not deny eligibility because there is no proof of tribal enrollment.
When a person is approved with a premium and later provides proof of tribal enrollment, the person is exempt from paying the premium beginning the month after the proof is provided.
Proof of Tribal Enrollment should be uploaded to HEAplus when it is found in Onbase. If there is an indication from case notes that this proof exists in an electronic format or an agency’s database and may be accessible to eligibility staff, check with your supervisor before asking the customer for proof.
Premiums begin with the month following the month in which the approval is dispositioned.
An approval notice or change notice is used to:
Show the customer how countable earned income was calculated;
Inform the customer of the premium amount;
Inform the customer of his or her right to appeal the amount of the premium; and
Advise the customer to report changes in income or work expenses that could cause a change in the premium amount.
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Term |
Definition |
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Freedom to Work (FTW) Premium |
An AHCCCS FTW premium is calculated for all customers who qualify for:
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Freedom to Work (FTW) Program |
The FTW program is for people with disabilities who are working. There are two FTW coverage groups:
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Program |
Legal Authorities |
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AHCCCS FTW FTW-ALTCS HCBS |
42 USC 1396a(a)(10)(A)(ii)(XV) and 42 USC 1396a(a)(10)(A)(ii)(XVI) ARS 36-2929 and ARS 36-2950 AAC R9-22-1909 |