Arizona Medicaid Is Changing—Stay Ahead With Paradigm
Arizona’s Medicaid program, AHCCCS, is undergoing major changes that will impact home care agencies across the state. With the transition from four to two MCOs and Sandata stepping down as the state’s EVV aggregator after October 1, 2025, agencies face shifting requirements, potential coverage gaps, and the risk of denied claims. Paradigm simplifies the complexities—handling eligibility, billing, and EVV support—so you can focus on delivering care while we ensure your reimbursements stay on track. Stay compliant, get paid faster, and keep your agency running smoothly with Paradigm.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinArizona.
Electronic Visit Verification
Upcoming changes and toss-ups to the complex web of Medicaid systems and payers can increase an already confusing scene; here we clear things up for you.
EVV Requirements
The open model Arizona uses allows providers to choose between Sandata or any EVV system of their choice.
EVV Aggregator
Currently, Sandata acts as the aggregator, but after October 1, 2025, AHCCCS will take over. If you plan to stay with Sandata as your agency's EVV, you’ll pay them and ensure your data flows correctly to the state’s in-house system.
EVV Billing Process
Submitting claims in Arizona varies depending on the payer. Most MCOs allow claims submission via a clearinghouse, while others require submissions through their specific online portals.
Rates
Arizona has some of the most appealing Medicaid rates in the country, with attendant care ranging from $26 to $35 per hour. In addition, there is a high volume of authorized hours per client.
It is important to note that MCO’s in Arizona tend to contract for 80% of the state rate. Therefore, it is vital to meticulously review every payer contract to ensure favorable rates. While the member transition to the newly contracted AHCCCS payers has been paused, providers will likely have to draft new contracts following the end of the health plan extension to September 2025.
Payers
State Direct:
The Arizona Health Care Cost Containment System (AHCCCS) authorizes and issues Medicaid for the state, ensuring comprehensive coverage for home care providers.
Managed Care Organizations (MCO’s)
Most home care providers contract with the branch ALTCS/EPD. ALTCS has 4 MCO'S as per the contract extension until September 2025:
- Banner University (exiting after contract extension)
- Mercy Care (exiting after contract extension)
- United Healthcare (remaining)
- Arizona Complete Health (remaining)
To see the current MCO coverage of your area, click here.
Reach out to Paradigm for assistance with the upcoming changes, updates, and all things Medicaid.
Frequently asked questions.
Yes, Veterans do indeed have a choice of care providers. As it states on the VA's website: 'Veterans can either choose their preferred community provider or a VA staff member can help select one. The selected community provider must be part of the VA’s network'.
