Applying for Medical Assistance (AHCCCS Health Insurance)

Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents.  AHCCCS provides medical insurance coverage to thousands of Arizonans each year.  It helps citizens obtain doctor’s office visits, physical exams, immunizations, prenatal care, hospital care and prescriptions they need.

Eligibility

AHCCCS offers many different medical programs.  DES only determines eligibility for the following programs:

• Medicaid for adults and children with limited income.
• KidsCare for uninsured children under the age of 19 who have income higher than the Medicaid limit.

Eligibility for the Medical Assistance program is based on the following requirements:

• Income
• Arizona residency
• Pregnancy
• Citizenship and qualified non-citizen status

The requirements differ for each program.  Under state and federal laws, individuals who qualify for medical assistance – except for Federal Emergency Medical Services – must be either U.S. citizens or qualified immigrants.  Find additional eligibility information.

You can screen for eligibility to see if you qualify for Medical Assistance; however, the best way to know if you are eligible is to submit a completed application for benefits and go through the application process.

Information needed to apply

Whether you are applying for the first time, or renewing your benefits, you may need one or more of the following pieces of information to complete your application:

• Proof of citizenship and identity for everyone who is applying for benefits.
• Alien Registration Cards, if there are non-U.S. citizens applying for benefits in your household.
• Social Security numbers for everyone, or proof that a Social Security number has been applied for.
• Birth certificates for everyone who is applying for benefits.
• Name, address & daytime phone number of landlord or neighbor.
• A statement verifying your address and the names of everyone living with you. The statement must be made by a non-relative who doesn’t live with you.  It must be signed, dated and include that person's address and telephone number.
• Proof of ALL money your household received from any source last month and this month.
• Proof that your employment ended and last date paid.
• Verification of any medical insurance other than AHCCCS.

Submitting your application

Submitting your completed application and required documentation starts the application process.  Once your application is received, it will be reviewed to determine if you qualify for benefits.  The following are ways that you can apply:

1. Complete and submit an online application through Health-e-Arizona Plus.
2. Download the Application for Benefits with KidsCare Application Addendum (PDF Form) and turn it in by mail, fax, or in person at your local office.
3. Request an application at your local office or Call (855) 432-7587 to request a paper application be mailed to you.  After receiving and completing the application, turn it in by mail, fax, or in person at your local office.
4. Go to find an assistor, enter your ZIP Code to locate community assistors near you for help with the application process.

Note: when you are applying for Medical Assistance for the first time you will need to select a health plan for each person applying for Medical Assistance.  If you do not select a plan, a plan will be selected for you.

After Application

We will call you and, when needed, send you a letter if we need any other information or proof to decide your case.

How do I provide additional information, when requested?

To serve you better and to make sure you get all the benefits you need, please:

• Provide all the information and proof as soon as possible
• Contact us if you need help getting information, so we can assist you

You can mail, fax or hand carry copies of the requested information to our office.  Please do not turn in original documents.

When you apply online at Health-e-Arizona Plus you can upload requested information or fax it with a cover sheet.  (For additional instructions, see the Frequently Asked Question (FAQ) in Health-e-Arizona Plus titled 'How do I fax documents to HEAplus')

When will I know if I am approved?

A decision will be made by one of the following dates:

• Within seven days from the application date if you are hospitalized
• Within 20 days from the application date if you are pregnant
• At the latest, 45 calendar days from the application date

When a decision is made regarding your case, you will receive a letter containing the results.  You can also monitor the status of your application online at Health-e-Arizona Plus.

What can I do if I disagree with the decision?

You can request an appeal when:

• An application is denied,
• Benefits are stopped, or
• An application is not acted upon in a timely manner.

After I am approved

Reporting Changes

You are required to report any changes that may affect your Medical Assistance eligibility.

Renewals

Based on your eligibility data from the prior application:

1. If there is enough information available to determine that you are still eligible, an approval letter is sent.
2. If eligibility cannot be determined, you will be sent a pre-populated renewal form with a Request for Information letter describing the information needed to complete the renewal.  The process can be completed through Health-e-Arizona Plus.  If you do not provide the requested information by the due date, your eligibility will be stopped.

If you are no longer eligible for the program you are currently enrolled in, you will be screened for eligibility in any other Medical Assistance program.