Arizona Health Care Cost Containment System - Division of Member Services

This report addresses the Division of Member Services’ processes for determining eligibility for AHCCCS healthcare programs and for providing services to members and providers through the AHCCCS Communications Center.  AHCCCS is responsible for seeing that eligibility for Medicaid is determined timely and accurately, but most eligibility determinations are actually performed by the Department of Economic Security (DES) under contract with AHCCCS.  DES began determining eligibility as of October 1, 2001, and initially experienced several difficulties that led to a number of concerns from hospitals about problems in determining whether their patients were eligible for Medicaid.  DES has been working to resolve the difficulties.  However, AHCCCS needs to increase its monitoring of DES' performance.  The report also discusses AHCCCS' performance of eligibility determinations for several programs other than Medicaid, and changes AHCCCS has or can make to improve efficiency.  Finally, this report notes several actions AHCCCS has taken to improve its Communications Center's operations, but notes that the Center should use customer satisfaction surveys to assess the quality of its services.