Benefits and Services
Welcome Molina Healthcare members!
Molina Healthcare (Molina) offers a full line of physical and behavioral health services for your body and your mind. With your Arizona Medicaid benefits, you get services like:
- Primary care provider (PCP) and specialist visits
- Medicines
- Hospital services
- Emergency care
- Pregnancy care
- Behavioral health services
- And more!
We can help you get rides to your doctor for covered medical appointments. Call (800) 424-5981 (TTY/TDD:711) to schedule a ride. Hablamos español.
A specialist is any licensed provider providing specialty medical services to members. Your PCP may refer you to a specialist when medically necessary, including for behavioral health services (transition-aged youth, trauma, substance use in adolescents, opioid use disorder, supportive and rehabilitation services), Autism Spectrum Disorder, services for members birth to five, and social determinants of health needs. Your PCP may communicate with a specialist directly to coordinate your care, or you may self-refer. If you or your PCP need help finding a specialty provider for any area in the Molina network, they may contact Molina at (800) 424-5981 (TTY/TDD: 711) and request a care manager. Some services require a prior authorization. Specialists must obtain a prior authorization from Molina before performing specific procedures or when referring you to non-contracted providers.
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Covered Services
- Behavioral health (refer to the covered behavioral health services for all members section below for more details)
- Breast reconstruction after mastectomy
- Chemotherapy and radiation
- Circumcisions, when medically necessary (prior authorization required)
- Diabetes testing and testing supplies
- Cardiac (heart) and pulmonary (breathing) rehabilitation
- Dialysis
- Durable medical equipment (DME) and supplies
- Emergency care (includes care to stabilize you after an emergency)
- Emergency dental care
- Limited to $1,000 per year
- Emergency and non-emergency transportation
- End of life care
- Family planning services
- Birth control
- Contraceptives
- Family planning counseling
- Hearing loss evaluation
- High tech radiology, including:
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiogram (MRA)
- Positron emission tomography (PET scan)
- HIV/AIDS therapy and counseling services
- Home health care
- Hospital services
- Inpatient
- Outpatient
- Immunizations (shots)
- Incontinence briefs (for members over 21 years of age, when needed)
- Inpatient hospital stays may include:
- Physical therapy
- Occupational therapy
- Speech therapy
- Laboratory, x-rays, medical imaging
- Maternity care
- Medical equipment and supplies
- Medical foods
- Nursing facility stay
- Limited to 90 calendar days per year
- Nutritional assessments and medical foods
- Occupational therapy
- Orthotics and prosthetics
- Out-of-network services
- Pain management services
- Physical therapy
- Podiatry (foot and ankle)
- Pregnancy care
- Prescription medications and injections
- Primary care provider (PCP) office visits, including:
- Wellness exams
- Preventive care
- Preventive screenings and tests:
- Pap tests
- Mammogram
- Colonoscopy
- Rehabilitation therapy
- Respirational therapy
- Specialist office visits
- Second opinions
- Surgery
- Smoking cessation
- Transplants that are approved by AHCCCS (organ and tissue)
- Urgent care
All members also get well visits as part of their covered services. As part of your wellness visit, you get services, but not limited to, well woman exams, breast exams and prostate exams for members 21 years and older. These also include a medical history, physical exam, health screening, health counseling and any medically necessary shots.
In addition to the covered services for all members, members under 21 years of age get the following benefits:
- Chiropractic care (when medically necessary)
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT) includes:
- Wellness exams
- Hearing exams and hearing aids
- Preventive dental care
- Orthotics covered for AHCCCS members under 21 years of age
- Dental screenings and treatments
- Glasses
- As part of EPSDT, glasses and other vision services, like replacing and fixing glasses, for members under 21 years of age are covered by AHCCCS. Molina has no limit for members for replacing and fixing glasses, when needed for vision correction. This includes, but is not limited to, loss, breaks or change in refraction. To get glasses replaced or fixed, EPSDT members do not need to wait for their next EPSDT well-child visit.
As a reminder, for members under 21 years of age, federal law requires AHCCCS to cover all services listed in 42 USC 1396d(a) when medically necessary and cost effective, even when the services are not listed as covered services in the AHCCCS State Plan, AHCCCS statutes, rules, or policies. This means that Molina will cover these services for EPSDT members if the treatment or service is necessary to “correct or ameliorate” defects or physical and behavioral illnesses or conditions, as long as the services are not experimental.
- As part of EPSDT, glasses and other vision services, like replacing and fixing glasses, for members under 21 years of age are covered by AHCCCS. Molina has no limit for members for replacing and fixing glasses, when needed for vision correction. This includes, but is not limited to, loss, breaks or change in refraction. To get glasses replaced or fixed, EPSDT members do not need to wait for their next EPSDT well-child visit.
- Outpatient physical, occupational and speech therapy
- Personal care services that are necessary to meet a medical need. This includes help with:
- Activities of daily care
- Bathing
- Toileting
- Walking
- Vision exams
Some services have specific limits:
- Behavioral health services
- See section below on covered behavioral health services
- Home-and community-based services
- Members should use the home-and community-based services instead of a nursing home when medically able
- Nursing home
- Up to 90 days per contract year (contract year is from October 1-September 30)
- Personal care items
- Only covered when used to treat a medical condition
- Vision care
- Limited to medical eye conditions
- Eye exams and glasses covered for children under 21 years of age
- Eyeglasses covered for adults after undergoing cataract surgery
- Orthotic devices
- Molina only covers orthotic devices when all three below are met:
- The orthotic is medically necessary
- The orthotic costs less than all other treatments and surgery to treat the same conditions
- The orthotic is ordered by a doctor or primary care practitioner (nurse practitioner or physician assistant)
- Molina only covers orthotic devices when all three below are met:
- Behavioral health counseling and therapy:
- Individual
- Group and family
- Screening, evaluation, assessment and testing
- Substance use services:
- Intensive outpatient
- Residential
- Inpatient
- Multisystemic therapy (for members under 21 years of age)
- Auricular acupuncture (a type of acupuncture that involves inserting needles into specific points on the ear) *
- Skills, trainings and development and psychosocial rehabilitation living skills training
- Behavioral health prevention/promotion education and medication training
- Help and training to maintain employment
- Laboratory, radiology and medical imaging
- Medical management
- Electroconvulsive therapy
- Care management
- Personal care services
- Home care training and family support
- Self-help and peer services
- Home care training for home care client
- Unskilled respite care
- Wraparound services to maintain supportive housing
- Behavioral health respite care
- Limited to 600 hours per year, October 1-September 30 (contract year)
- Sign language or oral interpretative services provided at no cost to the member
- Emergency and non-emergency transportation
- Crisis intervention:
- Mobile, community-based
- Stabilization, facility-based
- Over the phone via crisis line
- Hospital
- Subacute facility
- Residential treatment center
- Behavioral health residential facility (without room and board*)
- Supervised behavioral health services and day programs
- Community psychiatric supportive treatment and adult behavioral health therapeutic homes
- Partial Hospitalization Program (PHP)
*Services not available with Title XIX/XXI funding but may be provided if other funds are available
Molina members get prescription drugs and other pharmacy benefits from the plan with no copays or deductibles. Your drugs are covered when you show your member ID card at a network pharmacy when you get your prescriptions filled.
We use CVS Caremark to administer your pharmacy benefits. Visit the CVS Caremark website to:
- Order refills for existing and unexpired mail-order prescriptions
- Learn about potential drug-to-drug interactions
- Understand your drugs common side effects or significant risks
- Find out the availability of generic substitutions
- Find the location of an in-network pharmacy based on a proximity search by ZIP code
- Find out if a medicine has been recalled
You may qualify to have your regular medicine mailed to you. To get started:
- Call Member Services at (800) 424-5981 (TTY/TDD: 711)
- Talk with the representative and check if your medicine qualifies for this service
- Complete the request and your medicine will be mailed to you
You may also talk to you doctor if you have more questions about mail order services.
Do you need a ride to a medical appointment?
Molina partners with Veyo to provide you with NON-emergency medical transportation services.
Please call Veyo 3 business days before your appointment and have the following information ready:
- Your AHCCCS ID number
- Your appointment date and time
- Your medical provider’s name and address
- Your pick-up address
- The type of vehicle you need (standard/ambulatory, wheelchair, stretcher)
- Are additional passengers are traveling with you? One additional passenger is permitted.
To book your ride, call Veyo at (833) 474-5060 Monday-Friday between 8 a.m. - 6 p.m.
If you have questions, call Molina Member Services at (800) 424-5981.
View the list of covered transportation services prior to booking your ride.
Please note:
- Be ready 30 minutes before your scheduled pickup time.
- Urgent trips will be handled same day and are subject to a 1-hour service window from the time of your reservation.
- Urgent trips include:
- Discharges
- Dialysis
- Urgent care
- Cancer treatment
- Pre/post-surgery
- Surgery
- Wound care
- Same-day mental health - Member Services will call in to request these trips.
- Same-day pain management visits when your provider confirms you cannot wait to be seen within the normal 72-hour reservation notice.
- Same day doctor visits when you are sick and your physician confirms you cannot wait to be seen within the normal 72-hour reservation notice.
- Urgent trips include:
- Members under 18 years of age must be accompanied by an adult at least 21 years or older.
- You are required to provide all necessary child-safety/booster seats and durable medical equipment (wheelchair, scooters, canes, etc.).
- Reservations can be made for trips occurring in the current or following month
- For a return ride when you are not sure how long your appointment will last:
- Call Veyo at (833) 474-5060.
- Veyo has up to 60 minutes from the time of your call to pick you up.
Molina covers a comprehensive list of drugs chosen for their effectiveness by Molina and a team of doctors and pharmacists. This drug list, called a formulary, lists brand name and prescription drugs and lists any rules or restrictions that apply. We also cover many over-the-counter (OTC) medications when you have a prescription from your doctor. Visit the Molina Preferred Drug List to review the formulary or use the searchable formulary.
You pay nothing for covered prescription medications. Molina members have no annual deductible, no copays and no premiums.
Use the Find a Pharmacy tool to search for a network pharmacy near you. Our network includes many types of pharmacies and drugstores, including mail-order and specialty pharmacies.
There are two (2) ways to find your drug in the formulary:
- Search by medical condition:
Drugs are grouped by the medical conditions they are used to treat. If you know what the drug is used for, look for the category name, then the drug name. For example, drugs used to treat a heart condition are listed under the category Cardiovascular Medications.
- Search by drug name:
Use the index at the back of the book to search by drug name. Drugs in the index are listed alphabetically. Then, go to the page number listed beside the drug name to get information about the drug.
When you find your drug, any rules or special requirements are listed under the column titled Requirements/Limits. There are generally three (3) types of requirements your drug may have:
- Prior Authorization: indicated by PA in the Requirements/Limits column
- Quantity Limits: indicated by QL in the Requirements/Limits column
- Step Therapy: indicated by ST in the Requirements/Limits column
For medical exceptions, please have your provider call Member Services at (800) 424-5981 (TTY/TDD: 711). We’re available Monday-Friday 8 am-6 pm.
For certain drugs, you or your provider need to get preapproval (or prior authorization) from Molina before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
Learn how to request prior authorization from Molina.
Download the prior authorization form based on the type of prescription you need:
- Prior authorization request form
- Prescription drug prior authorization request form (Coming Soon)
- Specialty medication prior authorization request form (Coming Soon)
Molina limits the amount of certain types of medication you can receive in a certain time period. We do this to help ensure safe, cost-effective use of these drugs. For example, if it’s considered safe to take only one pill per day of a drug, we may limit the quantity you’re able to receive to 30 pills in a 30-day period.
In some cases, we require that you first try certain drugs to treat your medical condition before we will cover another drug for that same condition. For example, if Drug A and Drug B both treat the condition but Drug A costs less, you may need to try Drug A first. If Drug A doesn’t work for you, we’ll then cover Drug B. Your provider can learn more about how we determine whether step therapy is needed here.
There may be times when you need a drug that’s not on our formulary or that is on our formulary but has restrictions. When this happens, you can:
- Talk to your doctor to decide if you should switch to another drug on our formulary.
- Ask your doctor to request a formulary exception.
- In some situations, get a temporary supply of the drug.
In certain situations, we can provide a temporary supply of your drug. This applies to:
- New Molina members within the first 90 days of membership
- Current members affected by annual formulary changes during the first 90 days of the new year
- You may request a formulary exception in advance for the following year
During the transition period, we will automatically process a 30-day supply refill of your drug. Quantity may be less if your prescription is written for less than a 30-day supply. Once we cover the temporary supply, we generally won’t cover the drug again under our transition policy. You’ll receive a written notice explaining the steps you can take to request an exception or to work with your doctor on finding another drug on our formulary.
For new members residing in long-term care facilities, we’ll cover more than one refill during the first 90 days of membership. If you’ve been enrolled for more than 90 days, we’ll cover a temporary 31-day emergency supply (unless the prescription is for fewer days) while you’re pursuing the formulary exception.
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