AHCCCS; enrollment verification; presumptive eligibility, the official text

REFERENCE TITLE: AHCCCS; enrollment verification; presumptive eligibility

State of Arizona

House of Representatives

Fifty-seventh Legislature

Second Regular Session

2026

HB 2796

Introduced by

Representative
Carbone

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_STATUTE36-2903.18. Data matching agreements; review of member eligibility
information; 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 receive and review death records information from the
department of health services concerning members and shall adjust system
eligibility accordingly.

C. On at least a quarterly basis, the
administration shall receive and review information from 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. On at least a monthly basis, the
administration shall 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.

E. On at least a quarterly basis, the
administration shall receive and review information from 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.

F. 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.

G. 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.

H. 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.

I. 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.

J. 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.

START_STATUTE36-2903.19. 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.

Sec. 2. Effective date

This act is effective from and after December 31, 2026.