Last Updated: January 23, 2026
In 2026, Arizona Medicaid fees work two different ways. For members, fees mean small copays. For providers, fees mean payment rates. The Arizona Health Care Cost Containment System (AHCCCS) updated both on January 1, 2026.
These changes include the new state minimum wage of $15.15 per hour.
Quick Summary:
- Most AHCCCS members pay $0 monthly premiums
- Adult copays are $2.30 per visit in 2026
- Income limit for one person is $21,597 annually
- Provider rates increased 2.5% for many services
- New minimum wage affects home care worker payments
- Children pay no copays for any services
What Are Arizona Medicaid Fees for Members?
Arizona Medicaid fees for members are very low. Most people pay nothing each month. You only pay small copays when you visit the doctor or get medicine.
AHCCCS keeps costs low so families can afford healthcare. If you qualify based on Medicaid income limits 2026, you likely pay very little out of pocket.
2026 Member Costs at a Glance
| Cost Type | Amount | Who Pays |
|---|---|---|
| Monthly Premium | $0 | Most members |
| Doctor Visit Copay | $2.30 | Adults only |
| Prescription Copay | $2.30–$4.00 | Adults only |
| Emergency Room | $2.30 | Adults only |
| Children’s Copay | $0 | All children |
Children under 19 never pay copays. Pregnant women and nursing home residents also pay $0.
Who Qualifies for AHCCCS in 2026?
You must meet income rules to get AHCCCS coverage. Arizona uses 138% of the Federal Poverty Level (FPL) for most adults. This aligns with federal Medicaid eligibility 2026 standards.
2026 Income Limits:
- 1 person: $21,597 per year ($1,800 per month)
- 2 people: $29,172 per year ($2,431 per month)
- 3 people: $36,747 per year ($3,062 per month)
- 4 people: $44,367 per year ($3,697 per month)
These limits apply to Modified Adjusted Gross Income (MAGI). Some groups like pregnant women and children qualify at higher income levels.
You can check detailed Arizona Medicaid income limits 2026 on the official AHCCCS website.
What Are Arizona Medicaid Fees for Providers?
Provider fees are payment rates AHCCCS pays to doctors and hospitals. These rates are called Fee-For-Service (FFS) schedules. AHCCCS updates them every January 1.
The 2026 update includes important changes. Many rates went up 2.5% to match Medicare. Home care rates went up even more because of the new $15.15 minimum wage.
Key 2026 Provider Rate Updates
Physician Services:
- Updated January 1, 2026
- 2.5% increase for many procedure codes
- Follows Medicare fee schedule changes
Hospital Outpatient:
- Urban facilities: $1,441 base rate
- Rural facilities: $1,396 base rate
Home and Community Services:
- Adjusted for $15.15/hour minimum wage
- Required by Proposition 206
- Affects personal care and assisted living
Ambulance Services:
- Air ambulance rates updated October 1, 2025
- Ground transport often uses capitated payments
Outpatient Rate Growth (2020–2026)
| Year | Urban Rate | Rural Rate |
|---|---|---|
| 2020–21 | $1,298 | $1,258 |
| 2022–23 | $1,367 | $1,325 |
| 2023–24 | $1,404 | $1,361 |
| 2024–25 | $1,422 | $1,378 |
| 2025–26 | $1,441 | $1,396 |
Urban hospitals consistently receive higher base rates than rural facilities.
Understanding the Fee-For-Service Schedule
The AHCCCS Fee-For-Service schedule sets maximum payment amounts. It applies when providers bill AHCCCS directly. Most providers work with managed care plans instead.
Managed care organizations like Mercy Care or Arizona Complete Health negotiate their own rates. These rates usually match 100–105% of the FFS schedule.
Who Uses FFS Rates?
- Federal Emergency Services patients
- American Indian Health Program members
- Certain specialized populations
- Providers not in managed care contracts
Proposition 206 Wage Adjustment
Arizona’s minimum wage law requires annual rate increases. For 2026, the minimum wage is $15.15 per hour. This affects services that employ many direct care workers.
Services Affected:
- Personal care assistance
- Assisted living facilities
- Adult day care programs
- Home health aide services
Managed care plans must pass these increases to providers. This is mandatory, not optional.
Differential Adjusted Payments (DAP)
Some providers get bonus payments on top of base rates. These are called Differential Adjusted Payments (DAP). You must meet specific goals to qualify.
DAP Contract Year 2026 (Oct 1, 2025–Sept 30, 2026):
Providers who completed these tasks by late 2025 receive DAP:
- Participated in Health Information Exchange (HIE)
- Submitted social determinants of health data
- Met quality improvement benchmarks
- Achieved care coordination milestones
DAP appears as a percentage increase on your regular payment. The exact amount varies by provider type and achievement level.
How to Find Official Fee Schedules
AHCCCS publishes all fee schedules online. You can search by service type or procedure code.
Where to Look:
Physician & Dental Rates:
- Visit the AHCCCS Fee-For-Service Rates portal
- Download Excel files by specialty
- Search individual CPT codes
- Updated January 1 each year
Hospital Rates:
- Check the Inpatient/Outpatient Rates page
- Look for OMRB (Outpatient Monthly Rate Brief)
- Find DRG weights and base rates
Behavioral Health:
- Contact your managed care plan directly
- Rates vary by plan (Mercy Care, Arizona Complete Health, etc.)
- Services are integrated into ACC plans
Pharmacy:
- Review the AHCCCS Drug List (Formulary)
- Payment based on NADAC plus dispensing fee
- Some drugs require prior authorization
Transportation:
- Ground and air ambulance schedules
- Updated each Federal Fiscal Year (October 1)
- Non-emergency transport often capitated
All official schedules are available at AHCCCS.gov.
Applying for AHCCCS in 2026
If you need health coverage, apply through Health-e-Arizona PLUS. The application is free and available online 24/7.
Application Steps:
- Go to Health-e-Arizona PLUS website
- Create an account with email and password
- Enter household information (income, family size)
- Submit required documents (pay stubs, ID)
- Wait for eligibility decision (usually 7–10 days)
You can also apply by phone at 1-855-432-7587 or visit a local office.
Documents You’ll Need:
- Photo ID or birth certificate
- Proof of Arizona residency
- Recent pay stubs or tax returns
- Social Security numbers for household members
If your income changes during the year, report it within 10 days. This keeps your benefits accurate and prevents overpayment issues.
For complete requirements, check Medicaid fee schedule 2026 guidelines.
Frequently Asked Questions
How much does Arizona Medicaid cost in 2026?
Most AHCCCS members pay $0 monthly premiums. Adults pay $2.30 copays per doctor visit and $2.30–$4.00 for prescriptions. Children, pregnant women, and nursing home residents pay no copays at all.
What is the income limit for Arizona Medicaid in 2026?
For one person, the limit is $21,597 per year ($1,800/month). For a family of four, it’s $44,367 per year ($3,697/month). These amounts equal 138% of the Federal Poverty Level.
Did Arizona Medicaid provider rates increase in 2026?
Yes. Many physician rates increased 2.5% on January 1, 2026. Home care rates also went up to meet the new $15.15/hour minimum wage requirement under Proposition 206.
What does Fee-For-Service mean for AHCCCS?
Fee-For-Service (FFS) means AHCCCS pays providers for each service separately. This differs from managed care, where plans get monthly payments per member. Most Arizona Medicaid members are in managed care plans.
Do managed care plans have to follow AHCCCS fee schedules?
Not exactly. Managed care plans negotiate their own rates with providers. However, they must pass through mandatory rate increases like the Proposition 206 minimum wage adjustments for home care services.
Where can I find the official 2026 AHCCCS fee schedule?
Visit the AHCCCS Fee-For-Service Rates portal at AHCCCS.gov. You can download Excel files with all procedure codes and rates. Files are updated each January 1 for physician services.
Official Sources
All information comes from official government sources:
- Arizona Health Care Cost Containment System (AHCCCS)
- AHCCCS Fee-For-Service Rate Information
- Federal Poverty Guidelines 2026 – HHS.gov
Need help applying? Contact AHCCCS Customer Service at 1-855-432-7587 (Monday–Friday, 7 AM–6 PM MST). Representatives can answer questions in English and Spanish.
