Official Summary Text
SB1236 - 572R - Senate Fact Sheet
Assigned to
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VETOED
ARIZONA STATE SENATE
Fifty-Seventh
Legislature, Second Regular Session
AMENDED
VETOED
FACT SHEET FOR
H.B. 2796/S.B. 1236
AHCCCS; enrollment
verification; presumptive eligibility
Purpose
Effective January 1, 2027, establishes 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 plans
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 must provide: 1) inpatient and outpatient
hospital services; 2) laboratory and X-ray services; 3) prescription
medications; 4) medical supplies, durable medical equipment, insulin pumps and
prosthetic devices; 5) medical treatment of eye conditions; 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;
14) chiropractic services; 15) diabetes outpatient self-management training
services; and 16) traditional healing services, as specified (
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 Arizona 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 AHCCCS's terms of eligibility.
4.
Requires
AHCCCS, at least monthly, 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, at least quarterly, to redetermine eligibility of able-bodied adults
who are not American Indians or Alaska Natives and to receive and review
information indicating changes in circumstances that may affect eligibility
from:
a)
the Department of Economic Security, including changes to unemployment
benefits, employment status and wages; and
b)
ADOR, 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 state department in
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,
2027, 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.
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 for AHCCCS
coverage 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 coverage 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 coverage
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 is 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;
iii.
a description of
available appeals 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 appeals 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, 2027.
Amendments Adopted by
Committee
1.
Modifies the definition of
short-term limited duration insurance
to tie the length of the term to federal law.
2.
Makes technical changes.
Amendments Adopted by
Committee of the Whole
1.
The committee amendment was withdrawn.
2.
Requires AHCCCS, at least quarterly, to redetermine the eligibility of
able-bodied adult members who are not American Indians or Alaska Natives.
3.
Makes technical and conforming changes.
Governor's
Veto Message
The Governor
indicates in her
veto
message
that AHCCCS already maintains
eligibility verification processes and that new federal Medicaid eligibility
and work requirements will take effect January 1, 2027. For these reasons, the
Governor states that H.B. 2796 would result in duplicative or redundant state
obligations.
House Action
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Senate
Action
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(H.B. 2796 was substituted for S.B.
1236 on 3rd Read)
Prepared by Senate Research
February 23, 2026
MM/hk
Current Bill Text
Read the full stored bill text
SB1236 - 572R - S Ver
Senate Engrossed
AHCCCS; enrollment
verification; presumptive eligibility.
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1236
AN
ACT
amending
title 36, chapter 29, article 1, Arizona Revised Statutes, by adding sections
36-2903.18 and 36-2903.19; relating to the Arizona health care cost
containment system.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 29, article 1,
Arizona Revised Statutes, is amended by adding sections 36-2903.18 and 36-2903.19,
to read:
START_STATUTE
36-2903.18.
Data matching agreements; review of member eligibility
information; quarterly eligibility redetermination; waiver requests
A. The administration shall enter
into a data matching agreement with the department of
revenue
to identify members who have lottery or gambling winnings of $3,000 or
more. the administration shall review this information On at least a
monthly basis. If a member fails to disclose winnings of $3,000 or
more and is identified through the database match, the administration shall
consider the member's failure to disclose the information a violation of the
system's terms of eligibility.
B. On at least a monthly basis, the
administration shall
:
1. Receive and review death records
information from the department of health services concerning members and shall
adjust system eligibility accordingly.
2. 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.
C. On a quarterly basis, the
administration shall
redetermine the eligibility of able-bodied
adults who are eligible pursuant to section 36-2901, 36-2901.01 or
36-2901.07 and who are not american indians or alaskan
natives. For the purposes of the redetermination process, the
administration shall receive and review information from
both:
1. the department of revenue
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.
2. the department of economic
security concerning members that indicates a change in circumstances that may
affect eligibility, including changes to unemployment benefits, employment
status or wages.
D. Unless required by federal law,
the administration may not accept self-attestation of income, residency,
age, household composition, caretaker or relative status or receipt of other
health insurance coverage without independent verification before
enrollment. The administration may not request authority to waive or
decline to periodically check any available income-related data sources
to verify eligibility.
E. The administration may not accept
eligibility determinations for the system from an exchange established pursuant
to 42 United States code section 18041(
c
). The
administration may accept assessments from an exchange established pursuant to
42 United States code section 18041(
c
) but shall
independently verify eligibility and make eligibility determinations.
F. If the administration receives
information concerning a member that indicates a change in the member's
circumstances that may affect eligibility, the administration shall review the
member's eligibility.
G. The administration may execute a
memorandum of understanding with any other department of this state for
information required to be shared pursuant to this section. The
administration may 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.
H. On or before April 1, 2027, the
administration shall submit to the centers for medicare and medicaid services
any waiver requests necessary to implement this section.
END_STATUTE
START_STATUTE
36-2903.19.
Presumptive eligibility; limits; standards; notification;
training
A. The administration shall request
approval from the centers for medicare and medicaid services for a section 1115
waiver to allow the administration to eliminate mandatory hospital presumptive
eligibility and restrict presumptive eligibility determinations to children and
pregnant women eligibility groups. If approval for the section 1115
waiver is denied, the administration shall resubmit a subsequent request for
approval within twelve months after each denial.
B. Unless required by federal law,
the administration may not designate itself as a qualified health entity for
the purpose of making presumptive eligibility determinations or for any purpose
not expressly authorized by state law.
C. When making presumptive
eligibility determinations, a qualified hospital shall do all of the following:
1. Notify the administration of each
presumptive eligibility determination within five working days after the date
the determination is made.
2. Assist individuals who are
determined presumptively eligible under the system with completing and
submitting a full application for system eligibility.
3. 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 the
administration before the last day of the following month, presumptive
eligibility coverage will end on the last day of the following month.
4. Notify each applicant that if the
applicant files a full application for system eligibility with the
administration before the last day of the following month, presumptive
eligibility coverage will continue until an eligibility determination is made
on the application that is filed.
D. The administration shall apply the
following standards to establish and ensure that accurate presumptive
eligibility determinations are made by each qualified hospital:
1. Whether the qualified hospital
submitted to the administration the presumptive eligibility card within five
working days after the determination date.
2. Whether a full application for
system eligibility was received by the administration before the expiration of
the presumptive eligibility period.
3. If a full application was received
by the administration, whether the individual was found to be eligible under
the system.
E. If the administration determines
that a qualified hospital fails to meet any of the standards established under
subsection D of this section for any presumptive eligibility determination that
the qualified hospital made, the administration shall notify the qualified
hospital in writing within five days after the determination. The
notice shall include:
1. For the first violation, both of
the following:
(
a
) A
description of the standard that was not met and an explanation of why it was
not met.
(
b
) Confirmation
that a second finding will require that all applicable hospital staff
participate in mandatory training by the administration on hospital presumptive
eligibility rules.
2. For the second violation, all of
the following:
(
a
) A description
of the standard that was not met and an explanation of why it was not met.
(
b
) Confirmation
that all applicable hospital staff will be required to participate in mandatory
training by the administration on hospital presumptive eligibility rules,
including the date, time and location of the training as determined by the
administration.
(
c
) A
description of available appeals procedures by which a qualified hospital may
dispute the finding and remove the finding from the qualified hospital's record
by providing clear and convincing evidence that the standard was met.
(
d
) Confirmation
that if the qualified hospital subsequently fails to meet any standard for
presumptive eligibility for any determination, the qualified hospital will no
longer be qualified to make presumptive eligibility determinations under the
system.
3. For the third violation, all of
the following:
(
a
) A
description of the standard that was not met and an explanation of why it was
not met.
(
b
) A description of available appeals procedures by which a
qualified hospital may dispute the finding and remove the finding from the
qualified hospital's record by providing clear and convincing evidence that the
standard was met.
(
c
) Confirmation that, effective immediately, the qualified
hospital is no longer qualified to make presumptive eligibility determinations
under the system.
END_STATUTE
Sec. 2.
Effective date
This act is effective from and after December 31, 2026.