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 11, or call toll free 1-800-528-0142 then press 11.