Arizona Medical Assistance Program Benefits
Medicaid provides health coverage to millions of Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Arizona has expanded coverage to include low-income adults. Note: Medicaid is sometimes referred to by state specific names. Despite the different names, the programs are still Medicaid and are governed by federal Medicaid laws and regulations.
Arizona Medical Assistance Program
The 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, for which DES provides eligibility services. Health insurance through AHCCCS helps individuals cover the cost of doctor’s office visits, physical exams, immunizations, prenatal care, hospital care and prescriptions they need.
Who is eligible for Arizona Medical Assistance Program?
To be eligible for Arizona Medicaid, you must be a resident of Arizona, a United States citizen or a qualified immigrant (if the person is not a U.S. citizen or qualified immigrant, they may still be eligible for emergency services), have a Social Security number or apply for one unless they cannot get one legally, apply for potential income that may be available, such as unemployment, pensions, and Social Security, and have family income under the income limits. You may also be one of the following:
- Pregnant, or
- Be responsible for a child 17 years of age or younger, or
- Are Blind or have a disability or a family member in your household who is blind or with a disability.
Arizona Medical Assistance Program Income Limits
In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:
|Household Size||Maximum Income Level (Per Year)|
For households with more than eight people, add $6,836 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.Arizona Unemployment Insurance Program Benefits
Arizona Medical Assistance Program 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:
- Arizona residency
- 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. View 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 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.
- 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.
Applying for Arizona Medical Assistance
When you are ready, you can submit your application and required documentation.
DES has implemented virtual office services statewide to continue to better serve our customers and communities in this time of need while protecting the health and safety of our customers and staff. The easiest way to apply for benefits is online through Health-e-Arizona Plus. You may also begin the application process by phone by calling 1-855-432-7587.
Find a Community Assistor
If you need additional support, you can work with a Community Assistor to complete the application process. Go to Find an Assistor, enter your ZIP Code to locate community assistors near you for help with the application process. Contact the community assistor's office by telephone. In-person services may be unavailable or limited in manners that support social distancing.
Apply in Person
If you are unable to access services virtually, the DES Family Assistance Administration has offices statewide to assist you with the application process. Find your DES local office.
Mail or Fax an Application
request an application to be mailed to you by calling 1-855-432-7587. You can then complete the application and submit it by mail or fax. Instructions on how to do so are included in the application.
If we need any further information or evidence to make a decision on your case we may call you or send you a letter. You may be required to complete an eligibility interview by phone. We strongly recommend that you have income information, ID, Social Security number, and citizenship verification at the interview. During your interview, we will review your information to determine whether you are eligible for the program.
At the end of your interview, we will let you know when we need any additional information to make a decision on your case. We will also send you a letter asking for this information. Some of the program requirements may be difficult or dangerous for victims or survivors of domestic violence, sexual assault, sexual harassment or stalking and their families.
Talk to your DES eligibility specialist to determine if you may be exempt from these requirements. Your DES eligibility specialist can also provide you with information about sexual and domestic violence-related resources that are available in your community. We will keep all information you provide private in accordance with the law.
- Give us all requested information as soon as possible
- Let us know if you need assistance in getting the necessary information. We can assist you.
You can mail or fax copies of the requested information. Please do not turn in original documents. When you apply for Medical Assistance online, you can either upload requested information or fax it. Please include a cover sheet with your faxed documents. (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 when I’m 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 be mailed a letter with 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 processed 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:
- If there is enough information available to determine that you are still eligible, an approval letter is sent.
- 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.Nursing Education Loan Repayment Program Benefits
What if I need help with the application process?
You can also contact Community Assistors which help people complete and submit their Medical Assistance application. They will also help you understand eligibility rules and what may be required of you to participate in the program. Once your application is submitted, the Community Assistor may also help you get and submit verification documents (for example: pay stubs, proof of citizenship or legal resident status, etc.). Some Assistors will be available to guide you through the entire process, and others will provide you with access to computers, scanners, telephones, copy machines and/or fax machines that you can use for free.
You can find a Community Assistor in your ZIP Code on the Get Help screen of Health-e-Arizona Plus. Also, many SNAP Community Partners are also Community Assistors that can help you apply for Medical Assistance. It is recommended that you call the Assistor/Partner before visiting to make sure they offer the service you need and to make an appointment, if needed.
Are there any costs or fees that I need to pay for Medical Assistance?
There are no fees for applying for medical assistance. Some medical assistance programs may require the participant to make a co-payment when receiving medical services. Some co-payments are mandatory; the medical provider may not provide service if the mandatory co-payment is not paid. However, if you do not have mandatory co-payments the provider may ask for the co-payment, but cannot deny service when you are unable to pay.
You will receive a letter indicating whether you have mandatory co-payments. The letter also includes the services which require co-payment and amount of the co-payment. The co-payment may be waived by the medical provider. The KidsCare program requires payment of monthly premiums. If you need to pay a premium, AHCCCS will send a letter to you before your first premium is due.
When does my Medical Assistance coverage start?
Coverage for Medical Assistance in most cases begins the first day of the month that you are found eligible. The 'start date' will show on the Medical Assistance decision letter for each person who applied.
Where do I find information about health plans?
Go to AHCCCS Available Health Plans to find information about health plans, to pre-enroll, or to change enrollment in your anniversary month. You can also call (855) 432-7587 if you need health plan enrollment information. Once eligible, AHCCCS will send an AHCCCS ID Card with health plan information for each eligible person in your household.AIDS Research Loan Repayment Program Benefits
What if I already have medical bills?
If you have medical bills from up to 3 months before you applied for Medical Assistance, indicate this on your application and/or contact AHCCCS as soon as possible to discuss Prior Quarter Coverage. Medical bills prior to 3 months before you apply cannot be used.
What if my earnings increase?
When families are eligible for AHCCCS Health Insurance and an increase in their earnings cause them to no longer be eligible for family coverage, they may be eligible for AHCCCS Health Insurance under Transitional Medical Assistance. Do not voluntarily withdraw from AHCCCS Health Insurance just because your earnings increase. Medical coverage may continue for up to 12 months when:
- Your family received AHCCCS Health Insurance benefits in Arizona in three of the last six months; AND
- The person working is the parent or other relative caring for a minor child in the home. Please note that you must let DES know if your earnings increase by reporting a change. This will allow your eligibility for continued medical assistance to be decided under Transitional Medical Assistance.
Your family's eligibility for Transitional Medical Assistance coverage must be reviewed every six months. You must keep proof of your income and child care expenses over the six-month period and give it to DES at your review. Contact your local DES office for more information.
How do I apply for Arizona Medical Assistance Program?
To apply online, please visit the Health-e-Arizona PLUS online application portal. For additional application information, visit the Arizona Health Care Cost Containment System (AHCCCS) page. You will be able to download an application form directly from the site. You may also find out if you qualify through the Marketplace application.