About this page
The Quick Screener can give you a high-level estimate of the programs the persons in this household may qualify for, based on just three questions.
How to complete this page
Answer the three questions, then click on ‘Next’ to see the results. Be sure to enter the household’s ANNUAL income amount. A calculator is provided to help you.
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.