Free Declaration - District Court of Arizona - Arizona

EXHIBIT 21 TO SUPPLEMENTAL DECLARATION OF ELLEN KATZ

Case 2:03-cv-02506-EHC

Document 138-7

Filed 03/10/2008

Page 1 of 4

Fee-For-Service Provider Manual Recipient Eligibility and Enrollment Chapter: 2

October, 2003 Page: 2 - 1

OVERVIEW
All Arizona residents can apply for AHCCCS medical services or the Arizona Long Term Care System (ALTCS) program. There are many programs that individuals may qualify for in order to receive AHCCCS or ALTCS coverage. The programs have different financial and non-financial requirements that applicants must meet, including, but not limited to: Proof of Arizona residency at the time of application Proof of U.S. citizenship or legal alien status The Emergency Services Program provides coverage for most immigrants -- lawfully admitted immigrants as well as undocumented/illegal immigrants -- of emergency services and labor and delivery services only. An income test that requires applicants to provide documentation of all family earned and unearned income A resource test that requires applicants to identify resources (e.g., homes, other property, liquid assets, vehicles, and any other item of value) and provide documentation of their value A resource test is not applied for all eligibility programs. Other requirements Each program has certain non-financial and/or financial requirements, such as age, disability, pregnancy, medical "spenddown" or other household requirements that are unique to the program, and are aimed at serving specific groups of people.

ELIGIBILITY
Eligibility determination is not performed under one roof but by various agencies, depending on the category. For example, pregnant women, families, children and many individuals usually enter AHCCCS by way of the Department of Economic Security. The blind, aged or disabled who receive Supplemental Security Income enter through the Social Security Administration. Eligibility for categories such as ALTCS, SSI ­ Medical Assistance Only (aged, blind and disabled who do not qualify for Supplemental Security Income cash payment), KidsCare, AHCCCS for Parents of KidsCare Children (HIFA Parents), Freedom to Work, Breast and Cervical Cancer, and Medicare Cost Sharing programs is handled by the AHCCCS Administration. Each eligibility category has its own income and resource criteria.

AHCCCS Fee-For-Service Provider Manual Case 2:03-cv-02506-EHC Document 138-7 Updated: 02/20/2004

Filed 03/10/2008

October, 2003 Page 2 of 4

Fee-For-Service Provider Manual Recipient Eligibility and Enrollment Chapter: 2

October, 2003 Page: 2 - 2

ELIGIBILITY (CONT.)
AHCCCS provides family coverage under the following eligibility categories: AHCCCS for Families and Children (AFC) Medical Expense Deduction (MED) Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative HIFA provides coverage to parents of Title XIX SOBRA children and Title XXI KidsCare children who are not otherwise eligible for Medicaid. Coverage for children is provided under the following eligibility categories: ALTCS KidsCare KidsCare is Arizona's version of the Title XXI State Children's Health Insurance Program. It covers low-income children under age 19 if the family income is less than 200 per cent of federal poverty level (FPL). SOBRA SSI Cash (Title XVI) or SSI MAO Young Adult Transitional Insurance (YATI) Foster care children Coverage for single individuals and couples without minor children is provided under the following eligibility categories: ALTCS Breast and Cervical Cancer Treatment Program Medical Expense Deduction (MED) SOBRA Pregnant Women SSI Cash (Title XVI) or SSI MAO Title XIX Waiver Population Non-Spenddown Freedom to Work

AHCCCS Fee-For-Service Provider Manual Case 2:03-cv-02506-EHC Document 138-7 Updated: 02/20/2004

Filed 03/10/2008

October, 2003 Page 3 of 4

Fee-For-Service Provider Manual Recipient Eligibility and Enrollment Chapter: 2

October, 2003 Page: 2 - 3

ELIGIBILITY (CONT.)
Various Medicare cost sharing programs help recipients pay Medicare premiums, deductibles, and coinsurance. Qualified Medicare Beneficiary (QMB) Qualified Individual 1 (QI-1) Qualified Individual 2 (QI-2) was not funded and eliminated November 14, 2003 Specified Low Income Medicare Beneficiary (SLMB) Some eligibility categories provide partial coverage of AHCCCS-covered services: Family Planning Services (FPS) provides family planning services only for up to 24 months to SOBRA pregnant women after a 60-day post partum period. The federal Emergency Services Program (FESP) provides coverage of emergency services only to undocumented/illegal immigrants and some legal immigrants who do not qualify for full AHCCCS covered services. (See Chapter 18, Emergency Services Program) Benefits for KidsCare recipients are the same as under EPSDT except KidsCare recipients are not covered for licensed midwife services and home births.

NEWBORNS
All babies born to AHCCCS-eligible mothers are also deemed to be AHCCCS eligible and may remain eligible for up to one year if the newborn continues to reside with the mother and the newborn and mother continue to reside in Arizona. Newborns born to FESP recipients also are eligible up to one year of age. While the mother will be covered on a fee-for-service basis under FESP, the newborn will be enrolled with a health plan. Newborns born to mothers enrolled in KidsCare will be approved for KidsCare beginning with the newborn's date of birth unless the child is Medicaid eligible. Newborns receive separate AHCCCS ID numbers, and services for them must be billed separately using the newborn's ID. Services for a newborn that are included on the mother's claim will be denied.

AHCCCS Fee-For-Service Provider Manual Case 2:03-cv-02506-EHC Document 138-7 Updated: 02/20/2004

Filed 03/10/2008

October, 2003 Page 4 of 4