Arizona Medicaid Agency Prepares to Implement HR1 Eligibility Changes

October 2, 2026

AHCCCS Prepares Arizonans for New Eligibility and Engagement Requirements Under Federal Spending Package


A New Resource for Affected Members


The Arizona Health Care Cost Containment System, Arizona's Medicaid agency, has launched a statewide education effort to help Medicaid members prepare for new eligibility requirements and federal work and community-engagement requirements that take effect in January 2027.


The agency and community partners launched KeepMyAHCCCS.com in September as a central resource on the changes, which are expected to affect nearly 417,000 members. Under the federal law, certain adults enrolled through the Medicaid expansion will generally need to work, attend school, volunteer, or participate in another qualifying activity for at least 80 hours per month to maintain coverage, unless they meet certain criteria.


Humanitarian Immigrant Eligibility Restrictions Began Oct. 1


The first HR1 coverage changes took effect Oct. 1, when new federal eligibility restrictions for certain lawfully present immigrants began. Refugees, asylees, and several other humanitarian immigrant groups who previously qualified for full AHCCCS coverage will no longer be eligible for federally funded Medicaid coverage and generally will qualify only for emergency services coverage.


Lawful permanent residents, certain Cuban and Haitian entrants, and citizens of Compact of Free Association nations remain eligible if they otherwise meet AHCCCS requirements. AHCCCS has been notifying affected members, and the change could put more than 22,000 Arizona refugees at risk of losing their health coverage.


What This Means for Physicians


For physicians, the change could mean patients with ongoing medical needs — including those requiring medications, specialist care, and chronic-disease management — lose coverage even though they remain legally present in the United States, potentially creating gaps in care and increased uncompensated care.


Work Requirements Begin January 2027


Beginning in January 2027, the new requirements will apply primarily to adults ages 19 to 64 who enrolled through Medicaid expansion. Numerous exemptions apply, including for parents and caregivers of dependent children, people with disabilities or certain medical conditions, students, and other groups.


AHCCCS says members will receive information about whether the requirements apply to them and how to document qualifying activities or exemptions. Certain Medicaid expansion adults will also be required to complete eligibility renewals every six months rather than annually, and the federal changes will reduce the amount of retroactive coverage available to certain Medicaid expansion adults.


What's Next

AHCCCS says additional guidance and resources will be provided as the January 2027 implementation date approaches.


Source: Arizona Health Care Cost Containment System (AHCCCS). Additional information available at KeepMyAHCCCS.com.

Arizona Prison Health Care Oversight Moves Forward

By Admin User • October 2, 2026
State Attorneys Denied Emergency Stay on Court-ordered Receivership of Prison Health Care System The U.S. Supreme Court on Thursday denied Arizona's last-ditch effort to temporarily halt a court-ordered takeover of health care operations and management within state-run prisons. Without an emergency stay of the court's order, Arizona's Department of Corrections, Rehabilitation and Re-entry must turn over the management of its health care operations for roughly 25,000 incarcerated people to Annette Chambers-Smith, former director of the Ohio Department of Rehabilitation and Correction, beginning on October 19. Roots of the Case The dispute began in 2012 when inmates sued the department, alleging the prison system's inadequate medical, mental health, and dental care amounted to cruel and unusual punishment under the Eighth Amendment. The case went through years of litigation and a failed settlement agreement. In 2023, U.S. District Judge Roslyn Silver ruled that the health care system was "grossly inadequate." The court ordered the prison healthcare system to comply with more than 150 "quality indicators," but according to court-appointed monitors, the department failed to comply with 131 of the measures. In light of this finding, Silver mandated that health care in Arizona prisons would be overseen by Annette Chambers-Smith, former director of the Ohio Department of Rehabilitation and Correction, to take over as receiver effective Oct. 19. A Last-Ditch Appeal Attorneys for the Arizona Department of Corrections, Rehabilitation and Reentry asked the U.S. Supreme Court to delay a court-ordered receivership of the state's prison health care system. The request came after both a federal district court and the 9th U.S. Circuit Court of Appeals declined to pause the takeover. In the application, former U.S. Solicitor General Paul Clement, a representative of the department, argued that the state deserves more time to make its case before surrendering control of its operations, including oversight of its employees and health care budget. Arguments on Both Sides Clement argues receivership should have been the last resort and that Silver moved to it too quickly. He asserted that the department made measurable progress, including growing its health care staffing by more than 50%, expanding substance-use treatment access, and adopting a new care model. Corene Kendrick, deputy director of the American Civil Liberties Union National Prison Project, which represents the roughly 25,000 people incarcerated in Arizona prisons, called the department's request a "Hail Mary" and said Silver gave the department years of opportunities to comply before ordering receivership. What Happens Next Health care for thousands of incarcerated people will be managed under Chambers-Smith's oversight, as mandated by Silver, beginning on Oct. 19. The receivership affects all nine of Arizona's state-run prisons but will not impact health care for inmates in private facilities. Information in this article was sourced from the Arizona Mirror and Arizona's Family .

CMS Releases 2025 MIPS Final Scores — Physicians Have 60 Days to Contest

By Admin User • October 2, 2026
Eligible clinicians and group practices can request a targeted review of their final score before 2027 payment adjustments take effect. Final Scores Are Out, Adjustments Follow in About a Month The Centers for Medicare & Medicaid Services has released Merit-based Incentive Payment System performance feedback and final scores for the 2025 performance year. The 2025 final score determines the payment adjustment eligible clinicians and group practices will receive in 2027, and 2027 MIPS payment adjustments will be available in approximately one month. If an eligible clinician or group practice believes CMS calculated their final score or 2027 payment adjustment incorrectly, they must file a targeted review with CMS within 60 days. How the Targeted Review Window Works The targeted review window opened with the release of final scores and will close 30 days after the release of MIPS payment adjustments. CMS will announce the release of payment adjustments through the QPP listserv in approximately one month. CMS generally requires documentation to support a targeted review request, which varies by circumstance, and a CMS representative will contact applicants about any specific documentation required. If a targeted review request is approved and results in a scoring change, CMS will update the final score and, if applicable, the associated payment adjustment as soon as technically feasible. Common Reasons to File a Targeted Review Data were submitted under the wrong Tax Identification Number or National Provider Identifier. The clinician has Qualifying APM Participant status and shouldn't receive a MIPS payment adjustment. Performance categories weren't automatically reweighted despite qualifying for reweighting due to extreme and uncontrollable circumstances. How to Request a Targeted Review Sign in at qpp.cms.gov using HARP credentials, or ACO-MS credentials for Shared Savings Program ACOs — the same credentials used to submit 2025 MIPS data. Then click "Targeted Review" in the left-hand navigation. Source: American Medical Association, Centers for Medicare & Medicaid Services, Quality Payment Program