YH23-0001 - SMI Eligibility Determination

This solicitation seeks a qualified contractor to perform eligibility determination services for the State’s Serious Mental Illness (SMI) program under the Arizona Health Care Cost Containment System. The contractor will assess applicant data, apply statutory and regulatory criteria, and produce determinations that support enrollment decisions. The work likely includes data validation, eligibility scoring, reporting, and ensuring compliance with state and federal health‑care regulations. • Conduct comprehensive reviews of applicant information to confirm SMI eligibility. • Apply AHCCCS policy and Medicaid/Medicare guidelines to produce accurate eligibility rulings. • Generate detailed reports and dashboards for program administrators and auditors. • Provide ongoing support and recommendations for process improvements and compliance. • Coordinate with AHCCCS staff to address queries and resolve eligibility disputes.