You are invited to participate in a survey regarding your experience using the AHCCCS website. This survey will take approximately two minutes. Your responses will help us ensure that you have a high quality experience.
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.
Note: Health-e-Arizona is offered in both English and Spanish.
Click on the link to DES below if you (or the person you are applying for) are one
or more of the following:
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:
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.
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
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 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
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.