Arizona Health Care Cost Containment System - Medicaid Eligibility Determination

To receive Medicaid services through the Arizona Health Care Cost Containment System (AHCCCS), all applicants must meet various eligibility requirements and be approved for Medicaid through an eligibility determination process. AHCCCS shares the responsibility for determining applicant eligibility with the Department of Economic Security (DES). AHCCCS and DES accurately determined eligibility for almost all Medicaid applicants. However, auditors calculated that 5.92 percent of eligibility determinations are at risk for processing errors, and 1.11 percent of the eligibility determinations are at risk for being incorrect. Therefore, auditors estimated that AHCCCS is paying between $3.5 and $4.8 million in monthly capitation payments for enrolled but ineligible members. To help further ensure that Medicaid monies are spent only on those who meet eligibility requirements, AHCCCS should develop and implement a corrective action plan that will help ensure that it and DES address the errors identified. In addition, although none of the errors auditors identified were related to applicants’ citizenship, AHCCCS should ensure that it and DES make greater use of available electronic means for verifying citizenship to further enhance its eligibility determination process.