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Apply for AHCCCS Health Insurance/KidsCare

Apply Online

You can apply online for AHCCCS Health Insurance, KidsCare, Nutrition Assistance and Cash Assistance using Health-e-Arizona. You can apply for yourself, your family, or someone close to you. Health-e-Arizona will screen your application based on the information you entered and send your application to an office for a decision.

You may be able to reduce office visits and postage delays by using Health-e-Arizona.

Health-e-Arizona

Note: Health-e-Arizona is offered in both English and Spanish.


Print an Application

Click on the link to DES below if you (or the person you are applying for) are one or more of the following:

  • An adult without children
  • A family with children
  • A child only

You can use one application to apply for AHCCCS Health Insurance for everyone in your household. Applications for AHCCCS Health Insurance are available on the Department of Economic Security (DES) Application page:

Click on the link to the application below if you (or the person you are applying for) are one or more of the following:

  • 65 years of age or older
  • An individual who is blind or disabled
  • A working individual with a disability (Freedom to Work)
  • An individual that wants help with Medicare costs only

The application below is to apply for AHCCCS Health Insurance and/or Medicare Costs Sharing programs. To open the form so you can print it, click on the link below. These forms are saved in PDF format and you must have the Adobe Acrobat Reader installed in your browser to open them. If you don't have Adobe Acrobat, you can get it here.

Note: This application process does not apply for individuals who are in need of Arizona Long Term Care System (ALTCS) services, such as in home healthcare, nursing facility, or assisted living. To apply for Long Term Care, contact one of our ALTCS offices.

KidsCare II Re-Opens Updated

November 16, 2012

On November 1, 2012, AHCCCS reopened enrollment in the KidsCare II program and all applications are being considered for eligibility. Eligibility requirements for KidsCare II remain the same. Additionally, children on the wait list that was started Sept 7, are being automatically enrolled into the program if they meet the eligibility requirements for KidsCare II and do NOT need to reapply at this time. AHCCCS will continue to consider all applications for KidsCare II until the program reaches maximum enrollment based on available funding. More information about the KidsCare II program is available on the link below or call the toll free hotline (operated by a Community Partnership) at: 1-800-377-3536.

KidsCare II Applicants' Information Page

KidsCare II

August 24, 2012 Updated

As of August 17, 2012, there were 18,773 children approved for the KidsCare II program. Based on recent application and approval rates, AHCCCS anticipates the program will reach its funding capacity of 25,000 children sometime the week of September 3, 2012. At that time, the KidsCare II program will be frozen until further space becomes available. All applications will continue to be reviewed for Medicaid first and if it appears the applicant may be eligible for KidsCare or KidsCare II, the application will be placed on the wait list. Should additional space become available, the KidsCare Office will contact the applicant’s household. For more information about the program call the toll free hotline (operated by a Community Partnership) at 1-800-377-3536.

KidsCare II - Arizona's Temporary Children's Health Insurance Program (CHIP)

Overview

KidsCare II is a new children’s coverage program available May 1, 2012 through December 31, 2013, for a limited number of eligible children. KidsCare II has the same benefits and premium requirements as KidsCare, but with a lower income limit for eligibility. The income limit for KidsCare II is 175% of the Federal Poverty Level (FPL), based on family size. For additional background information on the KidsCare II program, please click on the link below:

KidsCare II Background

KidsCare Program

Enrollment in the KidsCare Program has been frozen since January 1, 2010 due to lack of funding for the program, however, you can still apply. DES will review your application first, to determine if your family may be eligible for AHCCCS Health Insurance or KidsCare II. If your children are not eligible for AHCCCS Health Insurance or KidsCare II, but it appears they may be eligible for KidsCare, and you are willing to pay a premium, DES will send their information to the KidsCare Office to add them to the KidsCare waiting list. The waiting list will be prioritized based on the date of the application. The oldest application date will be on the top of the list. If funding becomes available, the KidsCare Office will contact you.

The KidsCare Office is processing renewals and changes for eligible children. Families with eligible KidsCare children must complete their renewal and make their premiums on time to avoid losing KidsCare coverage.