Use this page to let us know that you cannot remember your Password, your User Name or both. We will help you create a new Password or get your User Name. PLEASE DO NOT CREATE ANOTHER ACCOUNT. CREATING ANOTHER ACCOUNT COULD CAUSE PROCESSING DELAYS.
If you forgot your Password, select “Forgot Password.” Enter your User Name and the characters in the picture, and click “Next.” You will be asked to confirm your identity. Once your identity is confirmed, you must create a new Password.
If you are not able to give us a valid User Name, select “Forgot User Name.”
If you forgot your User Name, select “Forgot User Name.” Answer the questions and enter the characters in the picture, and click “Next.” You will be asked to confirm your identity. Once your identity is confirmed, you will be given your User Name and must create a new Password.
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.