Assigned to RAGE FOR COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
FACT SHEET FOR H.B. 2449
AHCCCS; enrollment verification; presumptive eligibility
Purpose
Establishes, beginning January 1, 2026, enrollment verification requirements for the
Arizona Health Care Cost Containment System (AHCCCS) to confirm member eligibility and
standards for qualified hospitals to make presumptive eligibility determinations.
Background
AHCCCS serves as Arizona's Medicaid agency which offers qualifying Arizona residents
access to healthcare programs (AHCCCS). AHCCCS contracts with health professionals to
provide medically necessary health and medical services to eligible members including
low-income adults, children, pregnant women and individuals with disabilities. Statute outlines
both financial and non-financial eligibility requirements for a person to qualify as a member
(A.R.S. § 36-2901).
Currently, AHCCCS contractors are required to provide: 1) inpatient and outpatient
hospital services, excluding speech therapy; 2) laboratory and X-ray services; 3) prescription
medications; 4) medical supplies, durable medical equipment, insulin pumps and prosthetic
devices; 5) treatment of medical conditions of the eye; 6) early and periodic health screening and
diagnostic services; 7) family planning services; 8) podiatry services; 9) nonexperimental
transplants; 10) emergency dental care; 11) ambulance and nonambulance transportation;
12) hospice care; 13) orthotics; and 14) diabetes outpatient self-management training services
(A.R.S. § 36-2907).
There is no anticipated fiscal impact to the state General Fund associated with this
legislation.
Provisions
1. Requires AHCCCS to enter into a data matching agreement with the Department of Revenue
(ADOR) to identify members who have lottery or gambling winnings of $3,000 or more.
2. Requires AHCCCS to review the information on lottery or gambling winnings on at least a
monthly basis.
3. Requires AHCCCS, if a member fails to disclose winnings of $3,000 or more and is identified
through the database match, to consider the member’s failure to disclose the information a
violation of the system's terms of eligibility. FACT SHEET
H.B. 2449
Page 2
4. Requires AHCCCS, on at least a monthly basis, to:
a) receive and review death record information from the Department of Health Services
concerning members and adjust system eligibility accordingly; and
b) review information concerning members that indicates a change in circumstances that may
affect eligibility, including potential changes in residency as identified by out-of-state
electronic benefit transfer card transactions.
5. Requires AHCCCS, on at least a quarterly basis, to:
a) receive and review information from the Department of Economic Security and the
Industrial Commission of Arizona concerning members that indicates a change in
circumstances that may affect eligibility, including changes to unemployment benefits,
employment status and wages; and
b) receive and review information from ADOR concerning members that indicates a change
in circumstances that may affect eligibility for the system, including potential changes in
income, wages or residency as identified by tax records.
6. Prohibits AHCCCS from:
a) 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, unless required by federal law;
b) requesting authority to waive or decline to periodically check any available income-related
data sources to verify eligibility; or
c) accept eligibility determinations of the system from a federally-facilitated exchange
established in accordance with federal law.
7. Allows AHCCCS to accept assessments from a federally-facilitated exchange established in
accordance with federal law.
8. Requires AHCCCS to independently verify eligibility and make eligibility determinations
from the assessments accepted from a federally-facilitated exchange.
9. Requires AHCCCS to review a member’s eligibility if it receives information concerning that
member indicating a change in circumstances that may affect eligibility.
10. Allows AHCCCS to:
a) execute a memorandum of understanding with any other department of Arizona for
information required to be shared in accordance with the eligibility verification
requirements; and
b) contract with one or more independent vendors to provide additional data or information
that may indicate a change in circumstances and affect an individual’s eligibility.
11. Requires AHCCCS, by April 1, 2026, to submit to the Centers for Medicare and Medicaid
Services (CMS), any waiver requests necessary to implement eligibility verification
requirements.
12. Requires AHCCCS to request approval from CMS for a section 1115 waiver to allow
AHCCCS to eliminate mandatory hospital presumptive eligibility and restrict presumptive
eligibility determinations to children and pregnant women eligibility groups. FACT SHEET
H.B. 2449
Page 3
13. Requires AHCCCS, if approval for the section 1115 waiver is denied, to resubmit a subsequent
request for approval within 12 months after each denial.
14. 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 purpose not
expressly authorized by state law.
15. Requires a qualified hospital, when making presumptive eligibility determinations to do all of
the following:
a) notify AHCCCS of each presumptive eligibility determination within five working days
after the date the determination is made;
b) assist individuals who are determined presumptively eligible under the system with
completing and submitting a full application for AHCCCS eligibility;
c) notify each applicant in writing and on all relevant forms with plain language and large
print that if the applicant does not file a full application for system eligibility with
AHCCCS before the last day of the following month, presumptive eligibility coverage will
end of the last day of the following month; and
d) notify each applicant that if the applicant files a full application for system eligibility with
AHCCCS before the last day of the following month, presumptive eligibility coverage will
continue until an eligibility determination is made on the application that was filed.
16. Requires AHCCCS to apply the following standards to establish and ensure the accurate
presumptive eligibility determinations are made by each qualified hospital:
a) whether the qualified hospital submitted to AHCCCS the presumptive eligibility card
within five working days after the determination date;
b) whether a full application for system eligibility was received by AHCCCS before the
expiration of the presumptive eligibility period; and
c) whether the individual was found to be eligible under the system if a full application was
received by AHCCCS.
17. Requires AHCCCS to notify a qualified hospital in writing within five working days after
AHCCCS determines that the hospital fails to meet the established standards for any
presumptive eligibility determination made by the hospital.
18. Requires the determination notice to include:
a) for a 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 that all applicable hospital staff
participate in mandatory training by AHCCCS on hospital presumptive eligibility rules;
b) for a 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 appliable hospital staff will be required to participate in a
mandatory training by AHCCCS on hospital presumptive eligibility rules, including
the date, time and location of the training as determined by AHCCCS; FACT SHEET
H.B. 2449
Page 4
iii. a description of available appellate procedures by which a qualified hospital may
dispute the findings and remove the finding from the qualified hospital’s record by
providing clear and convincing evidence that the standard was met; and
iv. confirmation that if the qualified hospital subsequently fails to meet any of the
standards for presumptive eligibility for any determination, the qualified hospital will
no longer by qualified to make presumptive eligibility determinations under the system;
c) for a third violation:
i. a description of the standard that was not met and an explanation of why it was not met;
ii. a description of available appellate procedures by which a qualified hospital may
dispute the finding and remove the finding from the hospital’s record by providing clear
and convincing evidence that the standard was met; and
iii. confirmation that, effective immediately, the hospital is no longer qualified to make
presumptive eligibility determinations under the system.
19. Becomes effective on January 1, 2026.
House Action
HHS 1/23/25 W/D
APPROP 2/19/25 DPA 11-6-1-0
3
rd
Read 2/26/25 33-27-0
Prepared by Senate Research
March 17, 2025
JT/ci