401 Adults

Revised 10/01/2024

Policy

The conditions of eligibility for the Adult program are:

• Valid application (MA533);

• Age 19 to 64 (MA501);

• Resident of Arizona (MA531);

• Provide or apply for a valid Social Security number (MA532);

• US citizen (MA507) or appropriate noncitizen status (MA524);

• Does not qualify for Medicare (MA523);

• Children for which the individual is the primary caretaker must have insurance coverage (MA518);

• Assignment of rights to medical benefits and cooperation (MA503); and

• Income at or below 133% of the FPL (MA615.7).

 

Definitions

Term	Definition
Adult Program	The Adult group is for people who do not qualify for AHCCCS Medical Assistance (MA) in any of the following programs: Caretaker Relative; Pregnant Woman; SSI-MAO; and Young Adult Transitional Insurance (YATI).

 

Service Package

Customers who meet all of the requirements for the Adult program receive full AHCCCS Medical Assistance services package. Customers who meet all requirements except U.S. citizenship or qualified noncitizen status receive emergency services only. See MA302 for details about the service packages.

 

Enrollment

Customers approved for full coverage under the Adult program are enrolled in AHCCCS Complete Care (ACC) plan (Chapter 1100).

Emergency Services are paid for by AHCCCS on a fee-for-service basis.

 

Customer Costs

Customers do not pay a premium for coverage under the Adult program. Customers in the Adult program temporarily do not have co-payments.

 

Legal Authority

This requirement applies to the following program:

Program	Legal Authorities
Adults	42 USC 1396a(a)(10(A)(1)(XIII) 42 CFR 435.119 Title 9, Chapter 22, Article 14 of the AAC AAC R9-22-305