AHCCCS Programs and Covered Services

Eligibility Categories

AHCCCS offers medical programs and resources to serve Arizona residents who meet certain income and other requirements.

Select one of the following that best describes you (or the person you are applying for):

Covered Medical Services



AHCCCS contracts with several health plans to provide covered services. An AHCCCS health plan works like a Health Maintenance Organization (HMO). The health plan works with doctors, hospitals, pharmacies, specialists, etc. to provide care. You will choose a health plan that covers your zip code area. If you are approved, you will choose a primary care doctor that works with that health plan. Your primary doctor will:

  • Be the first person you go to for care
  • Authorize your non-emergency medical services
  • Send you to a specialist when needed

AHCCCS health plans provide the following medical services:

  • Doctor's Visits
  • Immunizations (shots)
  • Prescriptions (Not covered if you have Medicare)
  • Lab and X-rays
  • Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services for Medicaid eligible children under age 21
  • Specialist Care
  • Hospital Services
  • Transportation to doctor
  • Emergency Care
  • Podiatry Services Performed by a Podiatrist
  • Chiropractic Services
  • Pregnancy Care
  • Surgery Services
  • Physical Exams
  • Behavioral Health
  • Family Planning Services
  • Dialysis
  • Glasses, including replacements (for children under age 21)
  • Vision Exams (for children under age 21)
  • Dental Screening (for children under age 21)
  • Dental Treatment (for children under age 21)
  • Emergency Dental (for adults 21 and older. Up to $1000 per contract year)
  • Hearing Exams (for children under age 21)
  • Hearing Aids (for children under age 21)

Covered behavioral health services include:

Behavioral Health Day Programs including supervised day programs, therapeutic day programs, medical day programs;

Crisis Services including mobile team services, telephone crisis response, and urgent care Inpatient Services including hospital, sub-acute, and residential treatment;

Rehabilitation Services including living skills, cognitive rehabilitation, supported employment, and education support;

Health Promotion – Prevention, Education and Medication Training – education and standardized training for the purpose of increasing an individual’s behavioral knowledge of a health related topic such as medication management, the nature of an illness, relapse and symptom management, stress management, parenting skills and health lifestyles;

Residential Behavioral Health Services include a range of up to 24hr/day services in a structured living environment for individuals needing support.

Support Services including case management, personal assistance, Family & Peer Support, therapeutic foster care, respite, housing support, interpreter services, transportation, assistance accessing community resources and locating and applying for benefits, child care connections; and

Treatment Services - counseling, consultation, assessment and specialized testing, and substance abuse treatment.

Coverage for Individuals Eligible for Arizona Long Term Care (ALTCS)

AHCCCS contracts with several program contractors to provide long term care services. An ALTCS program contractor works like a Health Maintenance Organization (HMO). The program contractor works with doctors, nursing homes, assisted living facilities, hospitals, pharmacies, specialists, etc. to provide care. You will also be assigned a case manager who will coordinate your care.

In addition to the services listed above, people who qualify for long term care can receive services such as:

  • Nursing Facility
  • Hospice
  • Attendant Care
  • Assisted Living Facility
  • Adult Day Care Health Services
  • Home Health Services, such as nursing services, home health aide, and therapy
  • Home Delivered Meals
  • Case Management
  • Dental Services (up to $1000 per contract year)

Note: This is a partial list of covered services

ALTCS Member-Directed Options

Member directed models or options allow members to have more control over how certain services are provided, including services like attendant care, personal care and homemaker services. The models are not a service, but rather define the way in which services are delivered. Member-directed options are available to most Arizona Long Term Care System (ALTCS) members who live in their own home. The options are not available to members who live in an alternative residential setting or nursing facility. ALTCS members or their representatives are encouraged to contact their case manager to learn more about and consider member-directed options.

Agency with Choice Resources

Agency with Choice a member-directed option available to ALTCS members living in their own home. Under the Agency with Choice option, the provider agency and the member enter into a relationship and share employer-based responsibilities for the paid caregiver. The provider agency maintains the authority to hire and fire the caregiver and provide or arrange for the required minimum standardized training for the caregiver. The member, or their individual representative, may choose to assume one or more of the following employer-based responsibilities:

  • Recruit and select caregivers, including specifying the qualifications of the caregiver over and above the standard qualifications required by AHCCCS
  • Dismiss caregivers
  • Manage caregivers, including determining duties and schedules
  • Supervise caregivers
  • Training caregivers, including identifying special training needs

AHCCCS Member Communication

Click on "Member Notice" for the latest communication regarding the new Agency with Choice, member-directed option. Click on "FAQs" for answers to common questions pertaining to Agency with Choice.

Self Directed Attendant Care (SDAC) Resources

Self Directed Attendant Care (SDAC) is a member-directed option that has been available to members since 2008. Under the SDAC option, the member or member’s legal guardian serves as the legal employer of the paid caregiver and assumes all employer-based responsibilities. The member or member’s legal guardian is supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding and paychecks for the caregiver.

Policy

Additional Information & Brochure

SDAC Brochure | Rich Text Version