Arizona Health Care Cost Containment System (AHCCCS) Application Information
How to Apply for Arizona Health Care Cost Containment System
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The Arizona Health Care Cost Containment System or AHCCCS is the Medicaid agency in the state of Arizona that gives health insurance programs to individuals and families who meet certain requirements. It is jointly funded by the state and the federal government.
There are several programs under the AHCCCS such as Medicaid, which is for individuals, including children who have limited income, and the Arizona's Children's Health Insurance Program (CHIP) known as KidsCare II - intended for eligible children who are below 19 years old. Qualified applicants will receive coverage that includes, but is not limited to: physical exams, doctor's office visits, hospital care, and immunizations.
The Arizona Health Care Cost Containment System (AHCCCS) engages with various health plans to give medical services. You must choose a health plan that covers your area before you are verified as eligible for any of the programs under the AHCCCS. After approval, you will then pick a primary physician who will be the first one you go to for your medical care and your family's. He/She will be the one to approve your medical assistance and send you to a specialist if necessary.
The medical services provided by the AHCCCS for the different insurance programs include the following:
- Doctor's office visits
- Physical exams
- Behavioral health
- Prescriptions (this isn't covered if you already have Medicare)
- Specialist care
- Laboratory and x-rays
- Hospital services
- Pregnancy care
- Surgery services
- Emergency care
- Transportation to doctor
- Podiatry services
- Annual well women exams
- Family planning services
Children who are below 21 years old may receive the following services:
- Early and Periodic Screening Diagnosis and Treatment or EPSDT services (for children who are eligible in Medicaid)
- Vision exams
- Hearing aids
- Hearing exams
- Dental treatment
- Dental screening
One of the health insurance programs under the AHCCCS - the KidsCare - provides medical assistance for kids who are 18 years old or younger. It is intended for children in families who have incomes between 100% and 200% of the Federal Poverty Level or FPL; however, enrollment into the program was frozen on January 1, 2010 due to the recent recession but you may still apply.
A temporary Children's Health Insurance Program (CHIP) called KidsCare II is available from May 1, 2012 up to December 31, 2013 for a limited number of around 20,000 eligible children. It has similar benefits like the last one, but the income limit for eligibility is lower - the limit is 175% of the FPL, based on the size of the family.
If it is your first time to be qualified for the AHCCCS medical assistance and are registered in a health plan, you may receive an ensured period of up to six months of medical care even if you aren't eligible anymore for the program. If this happens, the AHCCCS will inform you.
Once you become eligible, the coverage for the health insurance will begin at the first day of that month; the starting date will appear on the AHCCCS decision letter. You will receive an AHCCCS identification card with all the details of your health plan.
You may always view all the information in your health plan by signing up and logging in to AHCCCS.gov.
There are times when problems will be encountered and such can be resolved without taking any legal action. If you do not agree with an action or a decision regarding the programs of AHCCCS, it is your right to file an appeal - a legal review of the case known as a Fair Hearing in which a neutral judge will review the issue. To do that, you must complete and send the Fair Hearing Request Form ASA-1011A which you can access by going to the following link, and searching for "Fair Hearing Request" in the form search here.
The AHCCCS offers several medical assistance programs, each has different eligibility requirements but most of them are contingent on the applicant's 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 use the online prescreen tool 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 child's 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
Arizona Health Care Cost Containment System Application Instructions
There are three ways to apply for AHCCCS Medical Assistance including KidsCare II:
- Apply online by going to www.healthearizonaplus.gov 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.
- Search for the appropriate application by clicking and using the form to search for the document . 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.
- 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 using the AHCCCS Online Provider Portal. If you are unable to resolve a claims issue using the portal, please contact AHCCCS Claims Customer Service at 602-417-7670, option 4, between 7:30 am and 4 pm Monday through Friday.
You don't have to pay anything when you're applying for AHCCCS medical assistance; however, once you're 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.