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How to use or fill out state of Arizona AHCCCS program with our platform
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Click ‘Get Form’ to open the AHCCCS application in the editor.
Begin by filling out your personal information on Page 1, including your name, date of birth, and Social Security number. Ensure all details are accurate.
Indicate whether you are applying for AHCCCS Health Insurance or Medicare cost assistance by checking 'YES' or 'NO'.
Complete the income section by detailing all sources of income for yourself and any dependents. Attach verification documents if necessary.
On Page 3, select your preferred health plan from the list provided based on your county. Make sure to check if your doctor is part of that plan.
Review all sections for completeness and accuracy before signing the application. If needed, attach additional sheets for more information.
Submit your completed application by mailing it to the designated AHCCCS office listed on Page 4.
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Arizona Health Care Cost Containment System (AHCCCS) is Arizonas Medicaid agency that offers health care programs to serve Arizona residents.
How does AHCCCS work in Arizona?
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 doctors office visits, physical exams, immunizations, prenatal care, hospital care and prescriptions they need.
What is the income limit to qualify for AHCCCS in Arizona?
Income Limits Household SizeGross Monthly Income Limit Effective 02/01/2025 3 $2,954 4 $3,564 5 $4,173 Each additional person $610*2 more rows
What is the maximum income to qualify for food stamps in Arizona?
Medi-Cal Categories You are 19-64 years old and your familys income is at or below 138% of the Federal Poverty Level (FPL) ($21,597 for an individual; $44,367 for a family of four). You are a child 18 or younger and your familys income is at or below 266% of FPL ($85,519 per year for a family of four).
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