Apply for AHCCCS Health Insurance/KidsCare

Apply Online

You can apply online for AHCCCS Health Insurance, KidsCare, Food Stamps and Cash Assistance using Health-e-Arizona. You can apply for yourself, your family, or someone close to you. Health-e-Arizona will screen your application based on the information you entered and send your application to an office for a decision.

You may be able to reduce office visits and postage delays by using Health-e-Arizona.

Note: Health-e-Arizona is offered in both English and Spanish.

Print an Application

You can use one application to apply for AHCCCS Health Insurance and KidsCare for everyone in your household.

To open the form so you can print it, click on the link below. These forms are saved in PDF format and you must have the Adobe Acrobat Reader installed in your browser to open them. If you don't have Adobe Acrobat, you can get it here.

• Application for AHCCCS Health Insurance - English [PDF, 986KB]
• Solicitud para Seguro de Salud de AHCCCS - Español [PDF, 947KB]

• Application for Help with Medicare Costs Only [PDF, 148KB]
• Solicitud para División de Costos de Medicare solamente [PDF, 157KB]

Note: This application process does not apply for individuals who are in need of Arizona Long Term Care System (ALTCS) services, such as in home healthcare, nursing facility, or assisted living. To apply for Long Term Care, contact one of our ALTCS offices.