AHCCCS Freedom To Work

and Medicare Cost Sharing Presented By

David Cardinali

Community Work Incentives Coordinator

DIRECT Center for Independence, Inc.

Thank you to Magellan for the use of their presentation!

AHCCCS Freedom To Work

and Medicare Cost Sharing Presented By

David Cardinali

Community Work Incentives Coordinator

DIRECT Center for Independence, Inc.

Thank you to Magellan for the use of their presentation!

AHCCCSArizona Health Care Cost Containment System

Medicaid Coverage in Arizona

AZ’s Medicaid program is called the Arizona Health Care Cost Containment

System, or AHCCCS

To qualify for regular AHCCCS a single individual cannot have income that exceeds 100% of the 2011 Federal

Poverty Level, or $908

Programs With Additional Eligibility Requirements

Freedom To Work (FTW) -

•Medicaid buy-In for the disabled

Medicare Cost Sharing (MCS) -

•Help pay for some Medicare premiums, co-pays & deductibles

Freedom To Work (FTW)

Provides Medicaid services to qualified individuals with disabilities

who are employed.

Eligibility for Freedom to Work is determined by the AHCCCS

Freedom to Work Unit

Freedom To Work Benefits

Net monthly earnings limit of 250% of the FPL ($2,270 in 2011)

Social Security Disability Income is NOT counted.

Additional FTW RequirementsGeneral Eligibility Requirements

Ineligible for regular AHCCCS

Financial Criteria

Age Range (16-64)

Willing to Pay a Premium

FTW Eligibility Does Not Consider

Resources of applicant, spouse, or family

Unearned income of the applicant

Income of applicant’s spouse or family

FTW Basic Coverage

Disabled

Receiving Social Security Disability

Determined Medically Eligible by a PAS(Pre-Admission Screening)

Determined Disabled by DDSA(Disability Determination Services Administration)

FTW Basic Coverage Groups

Employed

Working Full or Part Time (at least 40 hours per month)

Paid at least minimum wage for working

Paying Social Security and Medicare taxes on earnings

NOTE: This also applies for self-employed

FTW Six Month Guarantee

The customer is guaranteed six months of AHCCCS coverage the first time he or she is approved for AHCCCS Medical Services.

NOTE: There are some exceptions to the 6 month guarantee.

FTW Six Month Guarantee Exceptions

Fails to pay the FTW premium Moves out-of-state Dies Voluntarily withdraws from AHCCCS program Is an inmate of a public institution Was factually ineligible when initially enrolled

with the health plan Is adopted

FTW Premiums

Net Countable Monthly Income Premium

$0 to $ 500.00 $0 $500.01 to $ 750.00 $10.00 $750.01 to $1000.00 $15.00 $1000.01 to $1250.00 $20.00 $1250.00 to $1500.00 $25.00 $1500.01 to $1750.00 $30.00 $1750.00 to $2257.00 $35.00

Eligibility Reviews

Renewals completed every 12 months Failure to provide requested information

can result in loss of AHCCCS coverage A re-evaluation of SMI diagnosis is

required every 12 months (must include current psychiatric notes)

FTW Unit

A customer 16 – 64 years of age who meets the non-financial criteria, is employed, and fails to meet the financial income limits for other Medicaid programs, will be referred to the Freedom to Work Unit.

The customer will be sent a notice to inform him or her of this process. (Similar to SSA’s disability determination process.)

Where To Apply for FTW

AHCCCS Freedom To Work Unit

801 East Jefferson MD 1600

Phoenix AZ 85034

Phone Number: 602-417-6677

Fax Number: 602-417-6675

www.azahcccs.gov or

www.healtheariona.org

Medicare

Statutory provision of Title XVIII of the Social Security Act that provides hospitalization and medical insurance to persons who are aged, blind, or disabled.

The recipient pays part of the insurance and the federal government subsidizes.

Medicare Part A, Part B, and Part D.

Medicare Coverage

Medicare Part A Coverage• Most individuals do not pay a premium based

on FICA deductions from wages. Medicare Part B Coverage

• Monthly premium ($96.40 in 2009, $110.50 in 2010, $115.40 in 2011 & $99.90 in 2012).

Medicare Part D Coverage• Prescription drug plan through Medicare.

• Medicaid customer’s get their prescription drugs through a Medicare drug plan.

Medicare Cost Sharing (MCS)

Qualified Medicare Beneficiary (QMB)

• AHCCCS Pays Premiums for Parts A and B

• AHCCCS Pays Deductibles, Co-Insurance, and Co-Payments Specified Low-Income Medicare Beneficiary (SLMB)

• Receives Medicare Part A

• AHCCCS Pays Premium for Part B Qualified Individual 1 (QI-1)

• AHCCCS Pays Premium for Part B

Medicare Cost Sharing Approval

It may take up to 90 days before:

● Social Security Administration stops deducting the premium amount from the applicants monthly check

● AHCCCS starts to pay the premiums

Medicare Buy In

There is no automatic Medicare buy-in under the AHCCCS Freedom to Work program

Customers who are approved for AHCCCS

Freedom to Work will continue to be responsible for payment of their Medicare premiums.

Freedom to Work customers can also apply for MCS.

Where To Apply for MCSAHCCCS - SSIMAO Office

801East Jefferson MD 3800

Phoenix AZ 85034

Phone Number: 602-417-5010

Fax Number: 602-258-4619

www.azahcccs.gov or

www.healtheariona.org

Application Processing

AHCCCS Central Screening Unit• Reviews the application

• Reviews supporting documentation/verifications

• Send a Request for Information as needed

• Determine eligibility for SSI MAO or MCS

• Send a decision notice

• Refer application if needed

• Complete eligibility reviews (renewals)

• Process applications within 45 days

Thanks to our presenters: Daniel Chavez, District Manager, South Tucson

SSA Office Ricardo Chavez, Professional Relations Officer,

Disability Determination Services Dan Frey, Office of Congresswoman Gabrielle

Giffords, Constituent Services Rep. Alicia Morado, Southern Arizona Legal Aid Linda Fischer, Arizona Center for Disability Law Dave Cardinali, CWIC, DIRECT Center for

Independence

Questions?