AHCCCS Printed Information Order Form

Publications Available
ID	Description	PDFs	Bulk Order Amounts
AH-001	Application for AHCCCS Health Insurance - The Application for AHCCCS Health Insurance, often referred to as the universal application. Primarily used for non-DES programs, such as KidsCare, SSI-MAO, Freedom to Work, and SSDI-Temporary Medical Coverage. Revised 11/07.	English Spanish
AH-801	Application for AHCCCS Health Insurance Companion Brochure - This brochure provides a broad overview of AHCCCS health insurance programs, services covered, who qualifies, cost, and where to apply. It is printed in English on the front and Spanish on back. Revised 3/07.	Bilingual
N/A	Arizona CoppeR_x Card brochure - The Arizona CoppeR_x Card is a prescription discount card available to all Arizona residents accepted in over 500 pharmacies across Arizona. Enrollment is free and prescription discounts range from 15% to 55%.	English Spanish
BA-01	Baby Arizona Brochure - The Baby AZ brochure provides some basic facts about the program and a contact phone number. It is printed in English on the front and Spanish on back.	not available
DE-810	Estate Recovery Brochure - The Estate Recovery brochure provides information regarding AHCCCS' estate recovery program including liens & claims that may be filed against an estate. Revised 7/07.	not available
DE-817	ALTCS Community Spouse Brochure - The Community Spouse brochure provides information regarding community spouse policy on resources, income and the share of cost and general ALTCS eligibility requirements. Revised 7/07.	not available
DE-818	ALTCS Resource Transfer Brochure - The Resource Transfer brochure covers general information related to transfers, sales, trades, exchanges, and conversions of resources for ALTCS eligibility purposes. Revised 1/07.	not available
DE-819	ALTCS Trust Brochure - The Trust brochure provides general information regarding the types of trusts used by ALTCS to determine eligibility. Revised 8/04.	not available
DE-828	Arizona Long Term Care System (ALTCS) Brochure - The ALTCS "Filing an application" brochure provides general information about the application process and basic requirements for the program. Revised 1/07.	not available
DE-832	Freedom to Work Brochure - The Freedom To Work brochure provides general information about the application process, income requirements and covered services for the FTW program. Revised 7/07.	not available
N/A	Early & Periodic Screening, Diagnosis, & Treatment (EPSDT) Brochure - The AHCCCS EPSDT brochure explains the importance of check-ups for infants and children of all ages, often referred to as well-child visits. It is printed in English on the front and Spanish on back.	not available
KC-001	KidsCare Program Poster - The 11" X 17" KidsCare poster provides some basic facts about the program and a contact phone number. It is printed in English on the front and Spanish on back.	Bilingual	Enter Number:
KC-002	KidsCare Program Brochure - The KidsCare brochure provides a broad overview of the program, including the cost, services provided, how to qualify, and how to apply. It is printed in English on the front and Spanish on back.	Bilingual

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