How To Apply
Residents can use a simple form
to apply for
AHCCCS health insurance for yourself and everyone in your
immediate family who lives with you.
Download
the application here, or ask us to send you one, fill it
in and mail it back with the needed papers to the address on
the application.
The instructions on the application (Page C-2)
will tell you what you need for most programs.
An AHCCCS eligibility specialist will review your
application to find the program or programs that you and your
family may qualify for. The eligibility specialist will send
it to the right agency or AHCCCS department(s) which will
decide your eligibility.
You will receive a phone call or a letter if there is
anything else you need to do or send.
Most programs do not need a face-to-face interview if we
can contact you by phone.
You can get an application or get help filling it in
between 8 a.m. and 5 p.m., Monday through Friday. Call
(602) 417-5010, then press 1, or call toll free 1-800-528-0142
then press 1.
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