HB 2449
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ARIZONA HOUSE OF REPRESENTATIVES
Fifty-seventh Legislature
First Regular Session
House: APPROP DPA 11-6-1-0
HB 2449: AHCCCS; enrollment verification; presumptive eligibility
Sponsor: Representative Carbone, LD 25
House Engrossed
Overview
Effective January 1, 2026, requires the Arizona Heath Care Cost Containment System
(AHCCCS) to enter into a data matching agreement with the Department of Revenue (DOR)
to identify members who have lottery or gambling winnings of $3,000 or more. Outlines
procedures for reviewing this information and presumptive member eligibility.
History
Established in 1981, AHCCCS is Arizona's Medicaid program that oversees contracted health
plans for the delivery of health care to individuals and families who qualify for Medicaid and
other medical assistance programs. Through contracted health plans across the state,
AHCCCS delivers health care to qualifying individuals including low-income adults, their
children or people with certain disabilities. Members must meet certain financial and non-
financial requirements to be eligible for AHCCCS (A.R.S. § 36-2901)
Statute outlines the covered health and medical services offered to AHCCCS members,
including: 1) inpatient hospital services; 2) outpatient health services; 3) laboratory and X-
ray services; 4) prescription medications; 5) medical supplies, durable medical equipment,
insulin pumps and prosthetic devices; 6) treatment of medical conditions of the eye; 7) early
and periodic health screening and diagnostic services; 8) family planning services; 9) podiatry
services; 10) nonexperimental transplants; 11) emergency dental care; 12) ambulance and
nonambulance transportation; 13) hospice care; 14) orthotics; 15) medically necessary
chiropractic services; and 16) diabetes outpatient self-management training services (A.R.S.
§ 36-2907).
Provisions
System Member Eligibility
1. Requires AHCCCS to enter into a data matching agreement with DOR to identify
members who have lottery or gambling winnings of $3,000 or more and directs AHCCCS
to review this information at least once a month. (Sec. 1)
2. Declares that a member who fails to disclose winnings of $3,000 or more and who is
identified by AHCCCS through the ADG and ASLC database match is in violation of
AHCCC's terms of eligibility. (Sec. 1)
3. Requires AHCCCS, at least once a month, to:
a) receive and review death record information from the Department of Health Services
concerning its members and to adjust system eligibility accordingly; and
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2449
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b) review information concerning members indicating a change in circumstances that
may affect eligibility, including changes in residency as identified by out-of-state
electronic benefit transfer card transactions. (Sec. 1)
4. Directs AHCCCS, at least once a quarter, to:
a) receive and review information from the Department of Economic Security and the
Industrial Commission of Arizona that indicates a change in members' circumstances
that may affect eligibility, including changes to unemployment benefits, employment
status or wages; and
b) receive and review information from DOR that indicates a change in members'
circumstances that may affect eligibility, including potential changes in income,
wages or residency as identified by tax records. (Sec. 1)
5. States that if AHCCCS receives information concerning a member that indicates a change
in the member's circumstances that may affect eligibility, AHCCCS must review that
member's eligibility. (Sec. 1)
6. Allows AHCCCS to enter into a memorandum of understanding with any other
department of this state to obtain the information required due the provisions of this act.
(Sec. 1)
7. Authorizes AHCCCS to contract with one or more independent vendors to provide
additional data or information that may indicate a change in an individual's
circumstances and eligibility. (Sec. 1)
8. Prohibits AHCCCS, unless required by federal law, from accepting self-attestation of
income, residency, age, household composition, caretaker or relative status or receipt of
other health insurance coverage without independent verification before enrollment. (Sec.
1)
9. Restricts AHCCCS from requesting the authority to waive or decline to periodically check
any available income-related data sources to verify eligibility. (Sec. 1)
10. Prohibits AHHCS from accepting eligibility determinations for the system under 42
U.S.C. § 18041(c). (Sec. 1)
11. Allows AHCCCS to accept assessments from the Federal Health Benefit Exchange under
42 U.S.C. § 18041(c) but requires AHCCCS to independently verify eligibility and make
eligibility determinations. (Sec. 1)
12. Requires AHCCCS to submit any waiver requests necessary to implement this act's
requirements to the Centers for Medicare and Medicaid Services (CMS) on or before April
1, 2026. (Sec. 1)
Presumptive Eligibility Determinations
13. Requires AHCCCS to request approval from CMS for a section 1115 wavier to eliminate
mandatory hospital presumptive eligibility and restrict presumptive eligibility
determinations to only children and pregnant women eligibility groups. (Sec. 1)
14. Declares that if the section 1115 waiver request for restricting presumptive eligibility is
denied by CMS, AHCCCS is required to resubmit a subsequent request within 12 months
of each denial. (Sec. 1) HB 2449
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15. Prohibits AHCCCS, unless required by federal law, from designating itself as a qualified
health entity for the purpose of making presumptive eligibility determinations or for any
other purpose not expressly authorized by statute. (Sec. 1)
16. Requires a qualified hospital making presumptive eligibility determinations to:
a) notify AHCCCS of each presumptive eligibility determination within five working
days of the determination being made;
b) assist individuals determined to be presumptively eligible by the qualified hospital
with completing and submitting a full application for AHCCCS eligibility;
c) notify each applicant in writing and on all relevant forms that if the applicant does
not file a full application before the last day of the following month, presumptive
eligibility coverage will end on the last day of the following month; and
d) notify each applicant that if they file a full application for AHCCCS eligibility before
the last day of the following month coverage will continue until an eligibility
determination is made on the filed application. (Sec. 1)
17. Outlines standards AHCCCS must establish and apply in order to ensure that accurate
presumptive eligibility determinations are made by each qualified hospital. (Sec. 1)
18. Requires AHCCCS to notify a qualified hospital that fails to meet the established
standards for any presumptive eligibility determinations within five days after the
determination:
a) for the first violation:
i. a description of the standard that was not met and an explanation of why it was
not met; and
ii. confirmation that a second finding will require all applicable hospital staff to
participate in mandatory training by AHCCCS on hospital presumptive eligibility
rules.
b) for the second violation;
i. a description of the standard that was not met and an explanation of why it was
not met; and
ii. confirmation that all applicable hospital staff are required to participate in
mandatory training by AHCCCS on hospital presumptive eligibility rules and the
date, time and location of the training as determined by AHCCCS;
iii. a description of available appellate procedures by which a qualified hospital may
dispute the finding and remove it from the hospital's record by providing clear and
convincing evidence the standards were met; and
iv. confirmation that if the qualified hospital subsequently fails to meet any of the
standards for presumptive eligibility the hospital will no longer be qualified to
make presumptive eligibility determinations under AHCCCS.
c) For the third violation:
i. a description of the standard that was not met and an explanation of why it was
not met; and
ii. a description of available appellate procedures by which a qualified hospital may
dispute the finding and remove it from the hospital's record by providing clear and
convincing evidence the standards were met; and
iii. confirmation that, effective immediate, the hospital is no longer qualified to make
presumptive eligibility determinations under AHCCCS. (Sec. 1)
19. Contains a delayed effective date of January 1, 2026. (Sec. 2)