May 24, 2023

Members Who Lose AHCCCS Coverage May Have Continuity of Care Option

AHCCCS members who have recently lost AHCCCS coverage and are now enrolled with another health insurance company may be able to continue seeing a previous health care provider to continue a course of treatment.

Arizona law allows a new member in a health insurance plan with a life-threatening illness or in the last trimester of pregnancy to continue an “active course of treatment” with their previous health care provider when certain requirements are met. This continuity of care lasts only for a limited time. The new member must send a written request to the new health plan in order to ask to continue care with a previous provider.

To get continuity of care with a previous provider, an individual must be a new member of a health insurance plan and:

1. Have a life-threatening disease or condition (continuity of care coverage is limited to not more than 30 days after the effective date of enrollment), or
2. Have entered the third trimester of pregnancy on the effective date of enrollment with the new health insurance plan (continuity of care coverage includes delivery and care up to six weeks after delivery when the care is related to the delivery.)

The new health insurance plan is required to provide this continuity of care with no ban on any preexisting condition(s) when:

1. The member submits a written request to the new health insurance plan to continue an “active course of treatment” with a previous provider,
2. The previous provider agrees in writing to accept payment at the rates of the new health insurance plan, and
3. The previous provider agrees to the new health insurance plan's other requirements.

Members with questions about getting continuity of care and treatment from a previous health care provider should contact their new health insurance plan as soon as they are no longer eligible for AHCCCS coverage.