You must be logged in to continue an application. Log in with the user name and password that you have already created for yourself
You need a Health-e-Arizona Plus account to apply online. Your account will be secure and will give you the ability to track and manage your benefits
Come back anytime. You need a Health-e-Arizona Plus account to apply online
You would not be eligible for an electronic signature without an an active account.
You might prefer to choose a different signature in the Signature Option section.
If you switch to the Hospital Presumptive Eligibility (HPE) at this point, you will NOT be able to use this application to submit as a full AHCCCS application. You will need to ensure that a full AHCCCS application is submitted later, if the HPE application is approved.
Select ‘Return to Full Application’ to continue the full AHCCCS application. You will have an opportunity to also submit a HPE application at the end of the full application process.
Select ‘Continue with HPE’ to apply ONLY for Hospital Presumptive Eligibility.
This application includes Nutrition Assistance and/or Cash Assistance. You will not be able to help your customer apply for these programs on this application if you choose to go to the Hospital Presumptive Eligibility (HPE) application.
Select ‘Return to Full Application” to continue applying for all programs.
Select ‘Continue with HPE’ to apply for ONLY Hospital Presumptive Eligibility. You will need to create another application if your customer wants to apply for Nutrition Assistance or Cash Assistance.
HPE is only available to persons who have not had HPE in the past 24 months.
Hospital Presumptive Eligibility (HPE) is not available to persons who are age 65 or older when there are no minor children in the household.
Hospital Presumptive Eligibility (HPE) is not available to persons who are receiving Medicare unless there are minor children in the household.
To continue this application for all persons in this application, click on the “Return to Full Application” button.
To continue applying for HPE for the other persons in this application, click on the “Continue HPE for Other Persons” button.
Click “OK” to return to the full application.