Arizona’s Medicaid program has taken steps to address barriers to dental services and improve the oral health and overall health of tribal populations through dedicated staff and regular engagement with tribes per their tribal consultation policy. Arizona, like several other states, is subject to federal tribal consultation requirements. Tribal consultation seeks to ensure that tribal leaders, the IHS, and 638 and Urban Indian organization leaders are included in government-to-government discussions with state or federal governments. Section 5006 of the American Recovery and Reinvestment Act of 2009 (ARRA) requires states in which one or more Indian health programs or urban Indian organizations provide health care services to establish a process for the state Medicaid agency to seek advice on a regular basis from IHS, tribally operated, and urban programs. States are required to submit this process as a state plan amendment (SPA) for approval by the Centers for Medicare and Medicaid Services (CMS). HHS and CMS also have tribal consultation policies.

Each state agency in Arizona must employ a Tribal Liaison and adhere to a tribal consultation policy per statute. Tribal Liaisons in each state agency collaborate and coordinate on mutual strategies through the Governor’s Office on Tribal Relations. Tribal Liaisons may also serve on other state entities or councils, such as the Arizona Advisory Council on Indian Health Care. Arizona’s Medicaid program, Arizona Health Care Cost Containment System (AHCCCS), has a unique tribal consultation policy that provides opportunities for regular communication and programmatic and policy review with input from tribal leaders and their IHS, 638, and Urban Indian Organization counterparts. 84 percent of Arizona’s Medicaid members are enrolled in a managed care health plan, while the majority of fee-for-service enrollees identify as AI/AN. The Tribal Liaison in AHCCCS’s Division of Community Advocacy and Intergovernmental Relations engages in regular communication with IHS and tribal-operated facilities. Tribal Liaisons work with tribes in Arizona, tribally operated health programs, urban Indian health organizations, and the IHS to serve as advocates and points of contact for health care issues affecting AI/AN AHCCCS members. AHCCCS-contracted health plans are also required to staff an individual to serve as a “Tribal Coordinator” to support AI/AN members enrolled in a managed care plan.

AHCCCS typically holds four tribal consultations a year, where discussion focuses on community-driven agenda items and other required topics, such as state plan amendments (SPAs) and waiver proposals. During the COVID-19 pandemic, these meetings began taking place monthly. This regular engagement allows for communication and bidirectional feedback between tribal leadership and AHCCCS on important issues affecting AI/AN persons.

AHCCCS covers these dental services for all Medicaid members, including members of the American Indian Health Program and/or Tribal Regional Behavioral Health Authorities

• Services for children under 21 years of age include: check-ups and sealants (prevention against cavities); emergency dental services; and all medically necessary therapeutic dental services, including fillings.
• Services for adults 21 years of age and over include: medical and surgical services furnished by a dentist only to the extent that such services: are emergency dental services, up to an $1,000 annual limit; or are medically needed treatments prior to a transplant or cancer treatments (cancer of the jaw, neck, or head).