Arizona Health Care Cost Containment System Application Instructions


There are three ways to apply for AHCCCS Medical Assistance including KidsCare II:

  1. Apply online by going to www.healthearizona.org and fill out all the needed information. Some details must be faxed to complete your application. You will find the fax cover sheets on the Providing Documents tab of the Health Arizona website.
  2. Download the FA-001-FF application by clicking this link and then submit it through fax or by going personally to the nearest Family Assistance Administration (FAA) office. You may use only one application form to apply for everyone in your family.
  3. Apply personally at a local FAA office, at the Department of Economic Security (DES) office, at the hospital, or at certain clinics.

The following are some of the items you may need when applying or reapplying for AHCCCS Medical Assistance for you and your household (this does not apply to every applicant):

  • Proof of identity and citizenship for each one in your household who is applying for the programs under AHCCCS.
  • If there are non-U.S. citizens in your family, include Alien Registration Cards.
  • Social Security numbers (if none, verification that a Social Security number has already been applied for).
  • Birth certificates.
  • Name and contact information of neighbor or landlord.
  • Registration for all motor vehicles.
  • Verification of all income your family has received from any source for the past two months.
  • Complete bank statement for the past months.
  • Proof of life insurance, retirement plans, securities, and savings bonds.
  • Proof of mortgage or rent, as well as utility bills for the past months.
  • Proof of pregnancy.
  • Verification of all medical costs for the most recent months./li>
  • Verification of childcare costs.
  • Proof of any medical insurance aside from AHCCCS.

After you have applied, you may check your application status online by going to the My Family Benefits Page. If you used the Health-e-Arizona website for applying, you may monitor the status on its home page by clicking here. Your application will be approved or denied within 45 calendar days or less, depending on your case.

You donít have to pay anything when youíre applying for AHCCCS medical assistance; however, once youíre enrolled, you may be required to make a co-payment, depending on the program. Certain co-payments are even compulsory.

The Health Insurance offered by the AHCCCS for eligible children does not have monthly premiums for those who qualify. If the income of a child exceeds the limit and is too high for the AHCCCS insurance, the child may still be eligible for KidsCare II at a low premium per month.


Eligibility Requirements

The AHCCCS offers several medical assistance programs, each has different eligibility requirements but most of them are contingent on the applicantís citizenship, income, and residency in the state of Arizona:

  • Citizenship: An individual must be a citizen of the United States or a qualified immigrant to be qualified to receive medical services (except Federal Emergency Medical Services), under federal and state laws.
  • Income: The income of an applicant must be equal to or less than the income limit for the particular program under the AHCCCS.

To qualify for the health insurance program for children in which there are no monthly premiums for those who are eligible, an applicant:

  • Must be a resident of Arizona
  • Must be a citizen of the United States or a qualified immigrant (if the kid is neither of the two, he/she may qualify for emergency services)
  • Must have a Social Security number (if none, the child must apply for one)
  • Must be below the income limit (you may view the table of the monthly income limits by clicking here).

If the income of the child is above the limit of this health insurance, the child may still receive medical services through the KidsCare II program at low monthly payment of not more than $40 for a single child or not exceeding $60 regardless of the number of children in a household.

The KidsCare II eligibility requirements are the following:

  • The child must be an Arizona resident
  • The applicant has to be 18 years old or below
  • Must be a U.S. citizen or a qualified immigrant
  • Must have a Social Security number (if none, the child must apply for one)
  • The childís income must be at or below the income limit of 175% of the FPL
  • Must not be presently covered by other medical insurance
  • The applicant must not be qualified to receive AHCCCS (Medicaid) medical assistance
  • Must not be eligible to receive coverage via a state agency employee
  • The child must belong to a household who is prepared to pay a monthly premium

You may view the tables showing the income limits at 175% of the FPL and the KidsCare II premium amounts by clicking here.

Home | Browse By State | Privacy Policy | Terms & Conditions | About Us | Contact