Arizona Medicaid Billing For Home Care Agencies
Arizona’s Medicaid program (AHCCCS) administers home and community-based services primarily through the Arizona Long Term Care System (ALTCS) and the Division of Developmental Disabilities (DDD). Major changes took place on October 1, 2025: AHCCCS has taken over as the state’s EVV aggregator from Sandata, and ALTCS MCO contracts have been realigned. Paradigm helps agencies stay compliant, manage EVV and billing, and avoid denials as these changes take effect.
Electronic Visit Verification
Arizona currently uses an open EVV model. Providers can choose their EVV vendor, but data must pass to the state’s aggregator. As of October 1, 2025, AHCCCS will launch its own in-house EVV system. Third-party EVV is still allowed. New requirements for identifying live-in caregivers are already in place for Sandata users, with a timeline pending for others.
All federally required data points must be captured: service type, recipient, date, location, caregiver, and start/end times. Arizona also added a requirement in 2025 for providers using Sandata to identify live-in caregivers; providers using third-party EVV systems have not yet been given a deadline for this requirement.
Effective October 1, 2025: AHCCCS has replaced Sandata with an in-house EVV system while maintaining an open EVV model. Providers may continue with Sandata or other vendors but must ensure successful integration with AHCCCS.
Billing is tied directly to payer systems. Claims are generally submitted directly to each MCO. For DDD, claims are processed through WellSky, with providers able to submit 837 files, enter claims manually, or submit paper CMS-1500s.
Rates
How much does Medicaid pay for home care per hour in Arizona?
Arizona Medicaid offers some of the most competitive rates nationally, with attendant care typically ranging from $26–$35 per hour. In addition, clients in ALTCS often receive a relatively high number of authorized hours.
However, providers should be aware that MCOs often contract with providers for a specific percentage of the state rate, so providers need to pay attention to their specific rate.
Payers
Arizona’s Medicaid is administered primarily through ALTCS (Elderly & Physically Disabled) and DDD (Developmentally Disabled).
- ALTCS MCOs (as of October 1, 2025):
- UnitedHealthcare Community Plan
- Banner–University Family Care
- Mercy Care Plan
- Arizona Complete Health
- DDD Health Plans (via DES/DDD):
- Mercy Care
- UnitedHealthcare Community Plan
- Tribal Health Program (THP)
Providers must contract directly with these plans to deliver services. Because ALTCS contracting can be competitive and difficult, many agencies may not have contracts with all available MCOs.
Rates
Payers
Frequently Asked Questions
Most states operate Medicaid waiver or community-based care programs that allow reimbursement for non-skilled services such as personal care, homemaker services, respite care, and attendant care. These programs are often administered through Home and Community-Based Services (HCBS) waivers, aging programs, disability waivers, or managed long-term services and supports (MLTSS) programs. Eligibility criteria, covered services, and billing requirements vary by state.
In many states, yes. Enrolling with the state Medicaid program is typically the first step, but agencies may also need to complete separate contracts, credentialing applications, or network enrollment with individual Medicaid MCOs before claims can be submitted for reimbursement. Requirements vary by state and payer.
Credentialing timelines vary by state and payer, but most home care agencies can expect the Medicaid enrollment and credentialing process to take anywhere from 60 to 180 days. Delays are often caused by incomplete applications, missing ownership documentation, background check issues, or required site visits. Agencies seeking participation with Managed Care Organizations (MCOs) should also account for additional contracting and payer credentialing timelines.
How Paradigm can Help
Paradigm offers a combination of tech and highly skilled people to bridge the gaps in:
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
& Eligibility
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Credentialling
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
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