Arizona offers voluntary community health worker (CHW) certification, but AHCCCS reimbursement requires a certified worker and an eligible provider arrangement. Community Health Representatives (CHRs) also participate in this framework. For workers and program leaders, certification, provider enrollment, covered services, referral requirements and documentation are separate steps that must fit together.
Arizona CHW quick facts
| Topic | Arizona guidance |
|---|---|
| Credential administrator | Arizona Department of Health Services (ADHS). [1] |
| General employment | Certification is voluntary for community health work generally; Medicaid has separate qualification conditions. [1, 2] |
| Basic eligibility | Age 18 or older and high school diploma or equivalent, plus a qualifying pathway. [1] |
| Experience pathways | Experience-only, training-plus-experience and IHS CHR training options, with different required evidence. [1] |
| Renewal | Two years; 24 continuing-education hours in that period. [1] |
| Standard fees | $100 application, $200 initial certification and $200 renewal, with specified waiver or discount provisions. [1] |
| Medicaid program | Arizona Health Care Cost Containment System (AHCCCS). [2] |
| Current service policy | AMPM 310-W, with a September 4, 2026 effective-date update. [2] |
| Covered categories | Navigation/resource coordination, education/training and health promotion/coaching under the policy conditions. [2] |
| Published codes | 98960, 98961 and 98962 in AHCCCS billing guidance. [3] |
| Billing organization | Eligible AHCCCS-registered provider; CHW organizations have a PT CH enrollment route. [2, 4] |
| Last reviewed | November 6, 2026 |
For program leaders
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What is a CHW or CHR in Arizona?
Arizona’s Medicaid policy describes a community-based frontline worker who connects health and social-service systems with the people they serve. Its umbrella terminology includes CHRs, navigators, promotoras and cultural health navigators. Retain the title used by the worker and employer, especially in Tribal programs. [2]
The practical work may connect health information with daily barriers: preparing for a visit, learning how to use a service, understanding a care plan or following through on a resource connection. The record should describe the actual support and participant response rather than use the job title as a service definition.
CHW scope, Medicaid coverage and another professional credential should remain distinct. A person who also holds a peer credential must identify the role used for the service. A CHW certificate alone does not qualify that worker to bill a peer recovery service. [3]
Is Arizona CHW certification mandatory?
Certification is voluntary for community health work generally. It becomes a Medicaid qualification condition for AHCCCS-covered CHW/CHR services. The current AMPM 310-W requires ADHS certification and provider retention of the evidence. [1, 2]
For hiring, separate three decisions: whether the person can perform the employer’s duties, whether ADHS has issued certification and whether the actual Medicaid arrangement permits the service to be billed. A worker may be valuable to a grant-funded team before completing a payer-specific qualification process.
Use the actual issued credential and its dates for verified status. An application receipt or completion certificate should not be displayed as active ADHS certification.
What are the Arizona certification pathways?
Arizona’s rule requires age 18, a high school diploma or equivalent and qualifying evidence. Routes include 960 recent experience hours, qualifying training with 480 recent hours, or IHS CHR training with the applicable 480-hour basic or 380-hour advanced experience option. The rule specifies the three-year experience window and application evidence. [1]
Choose the route that matches the worker’s documented preparation. Do not automatically send an experienced CHR through a different entry-level route or assume a short private course supplies all required experience.
Before enrolling, ask the training provider which core competencies it covers, who supervises experience, what award it issues and how it supports the ADHS application. Keep employer-verifiable dates and duties with the experience record. A total number without its source is difficult to review.
Which pathway fits the applicant’s evidence?
The ADHS application checklist separates the routes rather than requiring every applicant to complete a new training program. Use it with R9-16-802’s experience window and setting conditions. ADHS initial and reciprocity checklist, updated June 16, 2025.
| Existing preparation | Evidence route to discuss with ADHS |
|---|---|
| Experienced CHW or CHR | 960 qualifying experience hours, with supervisor verification |
| Accredited college CHW certificate | Certificate and 480 qualifying experience hours |
| Organization or CHW-trainer program | Competency-based program evidence and 480 qualifying experience hours |
| CHR National Training Program, basic | Basic certificate and 480 qualifying experience hours |
| CHR National Training Program, advanced | Advanced certificate and 380 qualifying experience hours |
For experience documentation, the checklist asks for names, the relevant organization, supervisor and title, competencies, dates, hours and the supervisor’s signed verification. Collect that evidence while the supervisor can still confirm the work. A résumé alone may not contain those details. ADHS checklist, page 1.
How does someone apply for Arizona CHW certification?
Use ADHS’s current licensing resources and the application instructions under Article 8. The application requires the relevant education, experience or training evidence and disclosures. An out-of-state credential has a separate evidence route under the rule; recognition should not be assumed from an uploaded certificate. [1, 5]
A practical sequence is:
- Select the applicable qualification route and identify missing evidence.
- Ask the training provider or employer for the required completion and experience verification.
- Complete the current ADHS application and any required disclosures through the accepted process.
- Resolve a request for additional information and retain the actual certification decision.
- Provide the issued evidence to the employer responsible for covered-service review.
Keep workforce application records separate from participant notes. The employer may need verification evidence, but participant-facing records do not need unrelated employment or personal application material.
How much does certification cost, and when is renewal due?
Article 8 lists a $100 initial application fee, $200 initial certification fee and $200 renewal fee. It also provides initial-fee waiver criteria and funding-dependent discounts. The two-year renewal requires 24 continuing-education hours and submission at least 30 days before expiry. [1]
Training tuition and other course expenses are separate from certification fees. Confirm the provider’s current price and any funded place before enrolling. A fee waiver should be documented under the actual rule rather than assumed for everyone in a cohort.
Maintain the issued expiry date, learning evidence and renewal decision separately. An internal continuing-education total does not prove ADHS has renewed the certificate.
What should a renewal file contain?
Keep the certificate’s actual expiration date and a course-level learning log. R9-16-806 requires education related to CHW competencies and beyond introductory knowledge. Its examples include health literacy, referral follow-up, outreach, coaching and system navigation. The renewal attestation does not eliminate the need to retain supporting education evidence. R9-16-805 and R9-16-806.
Recommended log fields are course title, provider, date, accepted hours, topic and completion evidence. Check an unfamiliar course against the rule before relying on it. Schedule time to obtain missing certificates before submitting the renewal rather than waiting until the 30-day filing point.
Does AHCCCS cover CHW and CHR services?
Yes, for qualifying services and provider arrangements. Current AMPM 310-W identifies health-system navigation and resource coordination, education and training, and health promotion or coaching. Eligibility includes a chronic condition, risk of one or a documented health-affecting barrier. [2]
The September 2026 policy gives examples of barriers and requires the relevant condition or barrier in the medical record. It also sets recommendation/referral and eligible-provider conditions. Use the policy for the actual service, not a generic assumption that every task performed by a CHW is covered. [2]
Older FAQs discuss education and exclude case-management billing under the listed CHW codes. Read those distinctions alongside the current policy, which expressly includes navigation and resource coordination. Do not wrongly exclude all navigation because it resembles coordination, or relabel unrelated case management as a covered CHW service. [2, 3]
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Who recommends services and who submits claims?
AMPM 310-W specifies eligible recommending provider types and eligible billing organizations. The CHW/CHR works under the direction of an eligible registered provider, and the organization maintains current certification evidence. These relationships are different from an ordinary staff-manager assignment. [2]
AHCCCS’s 2026 enrollment resource gives CHW organizations a concrete route: meet the applicable certification conditions, apply through the AHCCCS Provider Enrollment Portal (APEP), respond to review requests and receive the enrollment decision. Provider type CH should not be confused with a Community Service Agency or a worker’s individual credential. [4]
For managed-care members, the organization also needs the applicable plan contracting and billing arrangement. For fee-for-service or American Indian Health Program work, use the relevant AHCCCS manual. The employer’s eligibility and the worker’s certification both need to be established; neither is created by a software account. [3]
How are recommending, directing and billing roles different?
The September 2026 policy identifies physicians, physician assistants, registered nurse practitioners, certified nurse midwives, clinical nurse specialists and specified behavioral health professionals as recommending provider categories. The CHW also works under an eligible provider’s direction. The affiliated billing organization must be one of the policy’s listed registered provider types. These are separate checks. AMPM 310-W, pages 2 to 3.
A useful intake record connects the recommendation to the member, service and recommending professional. A separate staff record identifies the certified worker and expiration date. The billing configuration identifies the registered organization and payer. A single generic supervisor field cannot reliably represent all three relationships.
Is a CHW organization the same as a Community Service Agency?
No. AHCCCS’s April 2026 comparison distinguishes the two provider arrangements. It states that a CHW organization has no separate organizational CHWO license, while its individual CHWs must have ADHS certification. It then requires organizational enrollment through APEP. Community Service Agency credentialing and behavioral health service categories follow a different route. PEP-908, pages 1 to 2.
For a new community organization, use the CHW organization enrollment instructions that match the proposed services. Do not copy a peer-support or daily-living-support application merely because both programs work outside a clinic. Receive and retain the enrollment decision before configuring claims under that provider arrangement.
Which codes, units and rates apply?
The published FAQ identifies 98960, 98961 and 98962. It states an aggregate maximum of four units daily and 24 monthly per member, with prior authorization for medically necessary additional services and restrictions on combining the listed codes on the same day. Verify the applicable current billing manual and plan instructions for the service date. [3]
Use the official fee schedule for the actual effective period. A listed amount is not proof of coverage or every managed-care contract’s payment. Do not publish a single dollar figure as a universal Arizona CHW rate when the organization’s arrangement may differ. [6]
Record actual service facts and duration before calculating units. Group documentation should retain the session and actual participants; it should not create fictional individual visits. Keep an unsuccessful outreach attempt in the operational history without automatically turning it into a covered unit.
What should Arizona CHW documentation include?
The covered-service record needs to support the policy’s eligibility, referral and service conditions. AMPM 310-W directs documentation to the member’s medical record and the applicable documentation policy. [2]
For everyday operations, a useful note also identifies the worker, service date, method, participant goal, activity, response and next action. Keep the recommending provider, billing organization and evidence available to the reviewer without requiring the CHW to reconstruct them for every report.
Fictional example: A participant identifies a nutrition-access barrier. The CHW provides program-appropriate support, helps contact a resource and records the participant’s response. If the resource has not accepted the referral, retain the pending status. The support record and the payment decision should describe what actually happened.
How should corrections, signatures and repeated visits be handled?
AMPM 310-W points to Policy 940 for medical-record documentation. The current Policy 940 includes an October 1, 2026 update. Its general record rules require attributable electronic entries, documentation at the service or shortly afterward and a history showing who changed information and when. It prohibits cloning prior notes as if they described a new encounter. A typed name alone does not meet its electronic-signature requirements. AMPM 940, pages 2 to 4.
For a repeated coaching visit, start with what happened today: the member’s current barrier, support delivered, response and next action. Relevant prior information can provide context, but copying the previous note and changing only the date does not show the new service. Preserve the original and correction history when fixing a mistake.
For telemedicine, the policy requires identifying the visit type, such as audio-only or audiovisual. That documentation rule is separate from whether the particular CHW service and delivery method are payable. Verify the code and payer arrangement before offering a payment assurance. AMPM 940, page 4.
How should supervision and referrals work?
Separate operational supervision, certification-related training supervision and the provider relationship required by the covered service. Each has a different purpose. The actual organization should name who reviews notes, resolves resource barriers and approves payer configuration.
For referrals, define offered, accepted, sent, scheduled and completed. A resource declining the request is useful information, not a reason to erase the referral. Record the alternative discussed with the participant and the next follow-up owner.
When several organizations are involved, identify the accepted exchange method and response expectations. A directory link does not establish an interface, and a sent file does not prove the partner acted.
What should an Arizona program monitor?
A director should see workforce certification and renewal actions, records awaiting service review, participants overdue for contact and referrals without a response. Keep these categories separate so an enrollment problem is not hidden inside a caseload total.
For funders, distinguish unique participants, contacts, group attendance, referral outcomes and units prepared for billing review. One person receiving several contacts remains one person in an unduplicated report.
Common errors include treating a certificate as organizational enrollment, using an outdated service description, importing peer-service rules, assuming every navigation task is payable and counting a referral sent as a connection completed.
How can Smores Health support the program discussion?
Explore community health workflows, then bring your ADHS evidence checklist, provider relationship and a required report to a focused demonstration. Ask the team to show the participant record, review process and pending referral together.
See the Smores Health platform. Test one covered-service example, one activity needing review and a resource handoff that remains unresolved. Identify any configuration or partner interface work explicitly.
Book a program walkthrough for your Arizona CHW or CHR team. Request pricing based on the actual staff, supervision, reporting and implementation scope.
See it in your program
Build your program around a connected workflow.
Bring your forms and reporting needs. See how Smores Health connects service notes, supervisor review, and program reporting in a walkthrough focused on your team.
A 20-minute walkthrough for your program.
Frequently asked questions
Can an uncertified worker provide general CHW support?
Arizona’s framework permits community health services without voluntary certification generally. AHCCCS reimbursement has its own certification requirement. [1, 2]
Does a CHR need a completely unrelated training route?
The certification rule recognizes IHS CHR training pathways with specified experience evidence. Select the route that fits the worker’s actual preparation. [1]
Are all navigation activities excluded from AHCCCS CHW coverage?
No. Current AMPM 310-W expressly includes navigation and resource coordination under its conditions. Do not use the older FAQ’s case-management exclusion as a blanket navigation ban. [2, 3]
Does ADHS certification make someone an independent AHCCCS billing provider?
No. Establish the eligible billing organization and applicable provider and plan relationships separately. [2, 4]
Can an out-of-state CHW certificate be transferred automatically?
ADHS has a separate reciprocity application. Its checklist calls for at least one year of another state’s CHW or CHR licensure or certification, the relevant attestation and credential documentation. ADHS must still decide the application. ADHS checklist, page 2.
Is H0038 automatically the right code for CHW work?
No. A separate peer role and qualifying pathway are needed for peer services. Use the CHW/CHR service and current billing instructions for CHW work. [3]
What should an Arizona program do next?
Verify the worker’s route and current certification, identify the organization’s enrollment and payer arrangement, and map the participant service to the current policy. Then test the documentation and report with the same fictional record.
Book a program walkthrough with Smores Health using that workflow.
Sources
[1] Arizona Administrative Code, 9 AAC 16 Article 8, current published chapter. https://apps.azsos.gov/public_services/Title_09/9-16.pdf
[2] AHCCCS Medical Policy Manual 310-W, effective September 4, 2026 update. https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/310-W.pdf
[3] AHCCCS CHW/CHR FAQ, revision July 17, 2024. https://www.azahcccs.gov/PlansProviders/Downloads/CHW/CHW_CHRFAQs.pdf
[4] AHCCCS PEP-908, community service agencies and CHW organizations, April 2026. https://www.azahcccs.gov/PlansProviders/Downloads/APEP/PEP-908.pdf
[5] ADHS occupational licensing resources. https://www.azdhs.gov/licensing/blpo/index.php
[6] AHCCCS CHW fee schedules. https://www.azahcccs.gov/PlansProviders/RatesAndBilling/FFS/CommunityHealthWorker.html
[7] ADHS, Community Health Workers initial and reciprocity application checklist, June 16, 2025. Official application checklist.
[8] AHCCCS Medical Policy Manual 940, Medical Records and Communication of Clinical Information, effective October 1, 2026 update. Official record policy.