What does Medicaid cover in Arizona?
Arizona Medicaid, called AHCCCS, covers many types of needed healthcare. This can include doctor visits, hospital care, emergency care, prescriptions, pregnancy care, behavioral health services, and children’s dental and vision care. Exact coverage can depend on a member’s program and health plan.
What services does Arizona Medicaid cover?
AHCCCS-covered services may include:
Doctor and primary care visits
Checkups and physical exams
Vaccinations
Specialist visits
Hospital and surgery services
Emergency care
Pregnancy and maternity care
Prescription medicines
Lab tests and X-rays
Behavioral and mental health care
Substance use treatment
Family planning services
Transportation to covered healthcare visits
Children’s dental, vision, and hearing care
Certain home health and long-term care services
This is not a full list. Some services may need approval from the member’s health plan before they are provided.
Members can review the official AHCCCS covered-services list or contact their health plan.
Does Arizona Medicaid cover dental and vision care?
AHCCCS covers dental and vision services for enrolled children under age 21. This includes dental screenings and treatment, vision exams, and glasses when medically needed.
Coverage for adults is more limited.
AHCCCS currently lists emergency dental coverage for adults age 21 and older, with a statewide benefit limit. Some members may have other dental benefits based on their program or health plan.
Routine adult vision exams and glasses are not listed as a standard benefit for all adult AHCCCS members. Members should call their health plan before making an appointment to confirm what is covered.
Does AHCCCS cover mental health and substance use services?
Yes. AHCCCS covers behavioral health and substance use treatment.
Covered services may include:
Mental health assessments
Counseling and therapy
Psychiatric services
Medication management
Crisis services
Inpatient or residential treatment
Substance use treatment
Peer and family support
Case management and help finding community resources
For most children and adults enrolled in AHCCCS Complete Care, physical and behavioral healthcare are provided through the same health plan.
Certain members, including people who have been determined to have a Serious Mental Illness, may receive services through a different AHCCCS program or regional plan.
Members should contact their health plan when they need help finding a therapist, psychiatrist, substance use provider, or crisis service.
Does AHCCCS cover in-home care and long-term care?
AHCCCS covers some services that can be provided in a person’s home.
For regular AHCCCS members, this may include medically necessary home health services. The service must meet AHCCCS rules and may need approval from the member’s health plan.
People who need a nursing-home level of care may qualify for the Arizona Long Term Care System, also called ALTCS. ALTCS may cover services such as:
Nursing facility care
Home health services
Help from an in-home caregiver
Assisted living
Adult day health services
Hospice care
Home-delivered meals
Case management
ALTCS has separate medical, financial, and functional eligibility rules.
Nest Health also provides in-home and virtual healthcare to eligible Arizona families through participating Medicaid health plans. Nest’s services are different from ALTCS personal care or nursing-home services.
Does AHCCCS coverage differ by health plan?
AHCCCS health plans provide the same standard covered medical services. However, each plan may have a different:
Network of doctors and hospitals
List of covered medicines
Process for approving certain services
Transportation provider
Member support program
Extra or value-added benefits
Members can choose from the plans available in the county where they live.
| Plan name | Counties served | Key coverage notes | Contact or more information |
|---|---|---|---|
| Arizona Complete Health – Complete Care Plan | All Arizona counties | Provides AHCCCS Complete Care medical and behavioral health benefits. Provider networks and extra benefits may vary. | 1-888-788-4408 or Arizona Complete Health |
| Banner–University Family Care | Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, most of Pinal, Santa Cruz and Yuma; also ZIP codes 85542, 85192 and 85550 | Provides standard AHCCCS Complete Care benefits in its service area. | 1-800-582-8686 or Banner–University Family Care |
| Blue Cross Blue Shield of Arizona Health Choice | Apache, Coconino, Gila, Maricopa, Mohave, Navajo, most of Pinal and Yavapai | Participating Nest Health plan. Members should confirm whether Nest serves their location. | 1-800-322-8670 or Health Choice Arizona |
| Mercy Care | Gila, Maricopa and most of Pinal | Provides standard AHCCCS Complete Care benefits in its service area. | 1-800-624-3879 or Mercy Care |
| Molina Healthcare | Gila, Maricopa and most of Pinal | Provides standard AHCCCS Complete Care benefits in its service area. | 1-800-424-5891 or Molina Healthcare |
| UnitedHealthcare Community Plan | Gila, Maricopa, Pima and most of Pinal | Provides standard AHCCCS Complete Care benefits in its service area. | 1-800-348-4058 or UnitedHealthcare Community Plan |
“Most of Pinal” excludes ZIP codes 85542, 85192, and 85550. Plan availability and service areas can change. Members should use the official AHCCCS health plan directory to confirm current options.
How do I find out whether a service is covered?
Call the Member Services number on your health plan card.
Ask:
Is this service covered?
Do I need approval first?
Does this doctor or provider accept my plan?
Will I have to pay anything?
Can the plan help me schedule transportation?
Are there limits on how often I can receive the service?
It is best to check before receiving non-emergency care. Emergency care does not require you to call your plan first.
How can Nest Health help?
Nest Health brings medical, behavioral health, and social support services closer to eligible families.
Depending on where you live, care may be available in your home, virtually, or through another local care setting. Nest can care for children and adults in the same family and help families manage appointments and health needs.
Nest services may be available at no additional cost through your Medicaid health plan. Call 866-222-NEST (6378) to check your family’s eligibility.
