FAQs

Yes.  To find in-person help visit the Health Insurance Marketplace website: https://localhelp.healthcare.gov 

You do not have to have children to get Nutrition Assistance.

If you were already getting benefits, you MAY keep getting benefits if you ask for an appeal before the day your benefits are scheduled to stop or decrease. You must tell us you want your benefits to continue when you ask for an appeal.

 

You can NOT keep getting benefits while you wait for an appeal if:

·         You ask for an appeal after the day your benefits are scheduled to stop or decrease;,

·         Your application was denied;,

·         Your benefits stopped because the approval period ended;,

·         You got the maximum benefits you were allowed to get; or

·         The law changed.

Copayments

American Indian AHCCCS members do not have to pay AHCCCS Medical Assistance copayments if they ever received services at the following:

·         Indian Health Service tribal health programs, or

·         urban Indian health programs

Note: This does not mean they are exempt from Medicare Part B copayments.

Premiums

American Indian AHCCCS members do not have to pay premiums for AHCCCS Medical Assistance if they:

·         Are eligible to receive services at a Indian Health Service tribal health programs, or urban Indian health programs, and  

·         Have given us proof of their tribal membership

American Indians who qualify for AHCCCS Medical Assistance may choose either an AHCCCS health plan or the American Indian Health Program (AIHP).   

Click on this link for information about AHCCCS health plans you can choose: https://azweb.statemedicaid.us/HealthPlanLinksNet/HPLinks.aspx

Click on this link for more information about the AIHP:  https://azahcccs.gov/AmericanIndians/AIHP/

American Indians can change between AIHP and an AHCCCS health plan at any time.  However, you can only change from an AHCCCS health plan to another AHCCCS health plan once a year.

To let AHCCCS know your health plan choice login to your Health-e-Arizona Plus account.  You can also call 1-855-HEA-PLUS (432-7587).

You may be eligible for Cash Assistance if any of the following apply:

  
• You have a dependent child under the age of 19 who is in your care
  
• You have a child in your care who is receiving Supplemental Security Income (SSI)
  
• A child has been placed in your care who is in the custody of any of the following:
  • The Department of Child Safety (DCS)
  • A tribal court in Arizona
  • A tribal child welfare agency in Arizona
  
• You are in the Kinship Foster Care Program

To be eligible for Cash Assistance, all of the following must apply:

  
• You are not above the income limits.
  
• You or your spouse have not received more than 12 months of Cash Assistance benefits in the state of Arizona. The only exception would be in hardship cases or when an extension is granted.
  
• You live in Arizona.
  
• You are a U.S. Citizen or qualified noncitizen.
  
• Your children’s shots are up-to-date and they go to school.

Yes, the Tribal TANF program has an appeal process.

 

Contact the tribe or ask the Department of Economic Security for an appeal.  The tribe handles the appeal and makes the final decision. 

 

See FAQ "How do I ask for an appeal?" for more information.

A woman who is in her third trimester of pregnancy and has no other dependent children living with her may be eligible for Tribal TANF benefits.

If you have one of the following VA health care programs you meet the minimum coverage standard under ACA:  

•         Veteran’s health care program

•         Civilian Health and Medical Program (CHAMPVA)

•         Spina Bifida health care program

 

If you are not enrolled in VA health care, you can apply at any time by:

•         Visiting https://www.va.gov/health-care/how-to-apply/

•         Calling 1-877-222-VETS (8387)

•         Visiting your local VA health care facility

 

Even if you are enrolled in a VA health care program, you may still qualify for AHCCCS Medical Assistance or help paying your Medicare premiums.  To apply:

•         Click here to begin a Health-e-Arizona Plus application. 

•        Click here to find an assistor to help you with the application process.

Click here to go to the screening tool.

If you apply for AHCCCS and are not eligible, your application will be automatically sent to the Health Insurance Marketplace.  At the Marketplace, you may be able to get a tax credit and help to find lower cost health insurance: https://www.healthcare.gov/get-answers/

You can also find other resources at:  https://www.azdes.gov/

The Arizona Long Term Care System (ALTCS) program is for people who need ongoing care at a nursing facility level and are: At least 65 years old Blind or disabled, or Developmentally disabled. ALTCS customers do not have to live in a nursing home. Many get in-home care while they live in their own homes or an assisted living facility. At this time, ALTCS applications can only be submitted by phone or in person. To apply for ALTCS, call or visit an ALTCS office. click here for a list of phone numbers and office locations.

You can ask for an appeal:

•          On the Health-e-Arizona Plus website or

•          Call 1-855- HEA-PLUS (432-7587)

You can also ask for an appeal in writing:

•          By mail:
    PO Box 19009

          Phoenix AZ 85005

•          At a local office

If you ask for an appeal in writing you must include your name, Health-e-Arizona Plus Customer ID, and why you want an appeal.

You can check your benefits 24 hours a day by:

Visiting online: www.ebtEDGE.com Calling: o   Toll Free: (888) 997-9333 o   Toll Free: (800) 367-8939 (TTY Hearing Impaired)

ebtEDGE is a free mobile app for EBT cardholders. You can download ebtEDGE to your phone. ebtEDGE is available in the Apple App Store (iOS) and Google Play Store (Android). Through this secure app, you will be able to see:

Your benefit balances Benefit schedules The last 60 days of transactions made on your card Nutrition Assistance retailer and ATM locations

You will need to enter your EBT card number and PIN to access your account information.

You have the right to choose an AHCCCS health plan during the application process. American Indians may choose the American Indian Health Program or an AHCCCS health plan.  If you do not choose a health plan, one will be assigned to you.   If you have been enrolled in an AHCCCS health plan within the past 90 days, you may be enrolled with your previous health plan.

All AHCCCS health plans provide the following medical services:

•   Doctors Visits

•   Immunizations (shots)

•   Prescriptions (Not covered if you have Medicare)

•   Lab and X-rays

•   Specialist Care

•   Hospital Services

•   Transportation to doctor

•   Emergency Care

•   Pregnancy Care

•   Surgery Services

•   Physical Exams

•   Behavioral Health

•   Family Planning Services

•   Dialysis

•   Glasses (for children under age 21)

•   Vision Exams (for children under age 21)

•   Dental Screening (for children under age 21)

•   Dental Treatment (for children under age 21)

•   Hearing Exams (for children under age 21)

•   Hearing Aids (for children under age 21)

Each AHCCCS health plan has their own network of providers  (for example doctors, specialists, hospitals, labs, pharmacies)  and they may each have a slightly different drug formulary,   which is the list of prescription medicines they cover.

Before you choose a health plan, you may want to check with your doctor, pharmacy, or hospital to see if they work with the plan you want.

If you want more information about the doctors, specialists, or hospitals  that work with a health plan that serves your county,  contact the health plans listed at the following AHCCCS website:  

https://azweb.statemedicaid.us/HealthPlanLinksNet/HPLinks.aspx

Once you choose an AHCCCS health plan,let AHCCCS know your choice by calling 1-855-HEA-PLUS (432-7587).

You may be able to get Nutrition Assistance within 7 days from when we receive your application, if you qualify for emergency help.  To qualify for emergency help, you must have valid identification and:

·         Your monthly income, cash, and bank accounts are less than your rent or mortgage plus your utility costs, OR

·         Your monthly income is less than $150 and your cash and bank accounts are not more than $100, OR

·         At least one person in your household is a migrant farm worker and your cash and bank accounts are not more than $100.

You will get a letter when it is time to renew your benefits.

You can turn in a completed and signed application by:

• Mail: PO Box 19009, Phoenix, AZ 85005
• Fax: 602-257-7031 if faxing from area codes 602, 480, or 623; or 1-844-680-9840 toll free if faxing from any other area code.
• Going to a DES eligibility office.
• Online:
  • If you already have a Health-e-Arizona Plus account, log into your account. Click on “Report a Change” and select “Other Change.”
  • If you do not have an account, you will need to create an account and log in. Once logged in, click on “Begin a New Application.”
• Assistor: You can contact an assistor to help you complete your renewal.

You can also complete the renewal process by phone by contacting 1-855-HEA-PLUS (1-855-432-7587).

If you turn in an application more than 60 days before it is time for your renewal, the application will be considered a change. You will still need to complete the renewal process when it is time to renew. If you do not complete the renewal, your benefits will stop.

How do I retrieve my User Name?

To retrieve your User Name

1. Click on “Returning User Log In” on the Health-e-Arizona Plus home page
2. Click on the “Forgot User Name” link on the pop-up.
3. Enter the following information:
• First Name
• Last Name
• Date of Birth
4. Click Next

NOTE: HEAplus may need more information to find your User Name. When additional fields display, enter the information and click “Next” again.

5. Answer the secret questions that you selected for your account.
6. Enter the Characters which appear in the picture.
7. Click “Next.”
8. HEAplus will send you a Personal Identification Number (PIN) to the e-mail address on your account. If you have agreed to accept messages by text message, the PIN can also be sent to your cell phone.
9. Enter the PIN and click “Activate” to verify your account.
10. HEAplus will send your User Name to the e-mail address on your account. If you have agreed to accept messages by text message, your User Name can also been sent to your cell phone.

How do I reset my Password?

To reset your password

1. Click on “Returning User Log In” on the Health-e-Arizona Plus home page
2. Enter the following information in the pop-up:
• User Name
• Characters which appear in the picture
3. Click on the “Forgot Password” link on the pop-up.

NOTE: If you do not follow the steps above, HEAplus will take you to the “User Log In” page. If this happens, enter your User Name and the characters which appear in the picture.

4. Answer the secret questions that you selected for your account. Enter the characters which appear in the picture.
5. Click “Next.”
6. Create a new password using the password rules. Enter the new password. Enter it again to confirm the new password.
7. Enter the characters which appear in the picture and click “Next.”
8. Your new password can now be used to log in to your account.

Tribal TANF Programs may have different:

·         work requirements;

·         eligibility rules; and

·         benefit amounts.

There is a Federal and State lifetime limit for Cash Assistance. Benefits received before October 1, 2002, do not count toward either lifetime limit.

The Federal government limits a household to a lifetime benefit of no more than 60 months. Benefits received in any state count toward the Federal limit.

In Arizona, a household can get a lifetime benefit of no more than 12 months, unless the household meets any of the following:

  
• Has a child who is a ward of the state.
  
• Has a child who is in the legal custody of a tribal court in Arizona.
  
• Has a child who is in the legal custody of a tribal child welfare agency in Arizona.
  
• Has a hardship.
  
• Meets the qualifications for an extension.

If you have received 54 months of countable benefits in another state, you can still get 6 months of benefits in Arizona. You reach your Federal lifetime limit of 60 months when you have received the 6 months of benefits in Arizona. You will not be able to get more Cash Assistance, except in hardship cases or when an extension is approved.

Effective August 09, 2017, a household may get an extension of 12 additional months when all of the following apply:

  
• The household requests an extension.
  
• No adult has a sanction for noncompliance with the Jobs Administration during the household’s final month of benefits. The final month of benefits must be October 2017 or later.
  
• Children ages 6 - 15 years old are attending school, unless the child was excused.

Once the judge has made a decision, AHCCCS or DES must act on the case within 10 calendar days.

The following things affect when you can start getting your benefits:

·         The length of time it takes you to complete the application process

·         The length of time it takes you to give us information

·         The type of benefits you apply for

 

If we have everything needed, you could get your benefits the day after you apply.  By law, a decision about your application must be made in the following number of calendar days: 

 

Medical Assistance:

New Applications                                       45 calendar days

Pregnant Women                                       20 calendar days

When a disability determination is needed    90 calendar days

 

Nutrition Assistance:

New Applications                                       30 calendar days

Expedited (Emergency)                                7 calendar days

 

Cash Assistance:

New Applications                                       45 calendar days

Kinship                                                     20 calendar days

Legal Permanent Guardian                         20 calendar days

Grant Diversion                                          20 calendar days

Two-Parent Employment Program               45 calendar days

Refugee Cash Assistance                          45 calendar days

The first letter of your last name determines the day of the month your benefits are placed on your QUEST EBT card. 

 

If your name begins with:	Day of the month:
A or B	1st
C or D	2nd
E or F	3rd
G or H	4th
I or J	5th
K or L	6th
M or N	7th
O or P	8th
Q or R	9th
S or T	10th
U or V	11th
W or X	12th
Y or Z	13th

 

Note: If the day shown above falls on a weekend or holiday your benefits will still be placed on the card on that day.

ebtEDGE is a free mobile app for EBT cardholders. You can download ebtEDGE to your phone. ebtEDGE is available in the Apple App Store (iOS) and Google Play Store (Android). Through this secure app, you will be able to see:
 • Your benefit balances
 • Benefit schedules
 • The last 60 days of transactions made on your card
 • Nutrition Assistance retailer and ATM locations

You will need to enter your EBT card number and PIN to access your account information.

When you become eligible for Cash Assistance:

A QUEST Electronic Benefit Transfer (EBT) card will be mailed to you. This card works like a debit card. Your benefits are put on your EBT card after approval. It can take up to 48 hours for the benefits to appear the first time. After that, your benefits will be available at 5 a.m. on the first day of each month. You can get cash at Automated Teller Machines (ATM) and stores where EBT cards are accepted.

It is illegal to use your Cash Assistance benefits to make purchases or withdraw cash at Point of Sale machines and ATMs located inside the following:

Liquor stores Casinos Horse or dog racing facilities Adult entertainment establishments Medical marijuana dispensaries

You are not allowed to use your EBT card to purchase lottery tickets.

If more than 10% of the Cash Assistance benefits you receive in a six-month period are used out-of-state during the six-month period, you may be required to contact DES and explain your out-of-state usage.

ebtEDGE is a free mobile app for EBT cardholders. You can download ebtEDGE to your phone. ebtEDGE is available in the Apple App Store (iOS) and Google Play Store (Android). Through this secure app, you will be able to see:

Your benefit balances Benefit schedules The last 60 days of transactions made on your card Nutrition Assistance retailer and ATM locations

You will need to enter your EBT card number and PIN to access your account information.

No, if you are eligible for a Tribal TANF Program you must get benefits from that program.  If you are not eligible for Tribal TANF, you can apply for Cash Assistance through the State.

Anyone age 18 or over must fill out the Illegal Drug Use Statement form (FAA-1415A) to keep getting Cash Assistance. The form is available in the “Forms” section of the “Help Center“.

A drug test is needed if:

·         The answers on the Illegal Drug Use Statement indicate a test is needed or

·         Government or law enforcement documents show the use of illegal drugs within the past 30 days

When a drug test is needed, we will send a letter with the following information:

·         The location of the testing lab

·         The date that the drug test must be completed

Most people get AHCCCS coverage at no cost.  But, if your income is too high to qualify, you may get coverage at a low cost through other programs offered.

Premiums

Click here to see more information about premiums during the declared COVID-19 emergency.

Co-Payments

A co-payment is the amount you pay a health care provider when you receive a medical service.  Your co-payment amount will vary depending on which AHCCCS program you are enrolled in and the services you need.  For some AHCCCS programs, the provider can deny services if the co-payments are not made.  Co-payments for services are:

• $2.30 to $10.00 for prescriptions.
• Up to $30.00 for non-emergency use of an emergency room.
• $3.40 to $5.00 for outpatient visits for evaluation and management services including doctors’ office visits.
• $2.30 to $3.00 for physical, occupational or speech therapy.

Remember to report any changes in income because this may change your co-payment amount.

The following people are never asked to pay co-payments:

• Children under age 19.
• People determined to be Seriously Mentally Ill (SMI) by the Arizona Department of Health Services.
• Individuals through age 20 eligible to receive services from the Children’s Rehabilitative Services (CRS) program.
• People who are temporarily residing in nursing homes or residential facilities such as an Assisted Living Home and only when the acute care member’s medical condition would otherwise require hospitalization.  The exemption from co-payments is limited to 90 days in a contract year.
• People who receive hospice care.

Co-payments are never charged for the following services for anyone:

• Hospitalizations
• Emergency Services
• Family planning services and supplies
• Pregnancy related health care including tobacco cessation for pregnant women
• Services paid for on a fee-for-service basis

The county in which you live determines what AHCCCS health plan choices are available to you. Click here to see what health plans are available in your county and get contact information.

If you have a problem with your doctor or health plan, contact your health plan's Member Services department. The phone number can be found on your AHCCCS ID card or on the health plan’s website.

 

If you have a problem with your eligibility decision, call Customer Support at 1-855-HEA-PLUS (432-7587). 

After you ask for an appeal, you will have the chance to talk with an AHCCCS or Department of Economic Security (DES) worker. This is called a pre-appeal conference.

If you ask for an appeal over the telephone or in person during business hours the pre-appeal conference will happen at that time. If you ask for an appeal by any other method or by telephone after business hours, an AHCCCS or DES worker will call you to have the pre-appeal conference.

The pre-appeal conference gives you a chance to talk about your case with the worker. It also gives you the chance to get a copy of the law, rule or policy that was used to make the decision about your case. It is not mandatory to attend the pre-appeal conference, but it is suggested. Sometimes problems can be solved with the worker and you may not have to go to the appeal hearing.

If a solution is not reached at the pre-appeal conference, a Notice of Appeal letter will be sent to your mailing address. The letter will give you the date, time and location of the appeal hearing.

Official business days and hours:

         Monday through Friday 8:00 AM – 5:00 PM (Arizona Time)

         Closed State Holidays and for Work Furloughs

State Holidays:

         New Year’s Day – January 1

         Martin Luther King Jr. / Civil Rights Day - Third Monday in January

         President’s Day – Third Monday in February

         Memorial Day – Last Monday in May

         Independence Day – July 4

         Labor Day – First Monday in September

         Columbus Day – Second Monday in October

         Veterans Day – November 11

         Thanksgiving Day - Fourth Thursday in November

         Christmas Day – December 25

If the decision is in your favor, AHCCCS or the Department of Economic Security (DES) will make corrections within 10 calendar days.

If the decision is not in your favor, you may need to pay back any benefits you got while you were waiting for the appeal decision.

If you do not agree with the judge’s decision, you can ask for your case to be reviewed again. You have 15 calendar days from the date of the appeal decision to submit a written request.

If you withdraw your request, the decision that you filed your appeal for will stay in effect.  If you kept getting benefits while waiting for the appeal decision, you may have to repay those benefits.  Also, if you withdraw from the appeal you will not be able to file an appeal for the same issue again.

If you want to withdraw because the case was found to be incorrect and has been fixed, please speak with an appeal specialist first.

If you do not qualify for AHCCCS Medical Assistance, you may be able to get tax credits to help pay for your health insurance premiums.  Click here for more information.

You can also:

•         visit the Health Insurance Marketplace at https://www.healthcare.gov/getting-lower-costs-on-coverage/

•         call the Health Insurance Marketplace Call Center 24 hours a day at 1-800-318-2596 (TTY 1-855-889-4325)  

 

You can ask for an appeal if you do not agree with any of the following:

•          Your application has been denied.

•          Your benefits stopped.

•          Your benefits are reduced.

•          A decision is not made on your application within the required number of days and the delay is due to AHCCCS or the Department of Economic Security. For more information about application time frames, see FAQ "How long does it take to start getting benefits after I apply?"

For more information about appeals see the following FAQs:

•          "How do I ask for an appeal?"

•          "What is the deadline to ask for an appeal?"

•          "What happens after I ask for an appeal?"

•          "What happens at the appeal hearing?"

•          "Can I keep getting benefits while I wait for a decision on the appeal?"

See FAQ "How long does it take to start getting benefits after I apply?" for more information about the number of days to make a decision.

AHCCCS Medical Assistance is Arizona's name for Medicaid.  The medical coverage provided may include doctor's office visits, physical exams, shots, prenatal care, hospital care and prescriptions.

An Electronic Benefit Transfer (EBT) alternate card holder is an additional person that you can select to have an EBT card for your benefits.

 

You can have up to two EBT alternate card holders.  You can choose if they have access to Nutrition Assistance, Cash Assistance, or both benefits. 

 

The alternate card holder:

•         is issued their own EBT card

•         can select or is mailed their own EBT Personal Identification Number (PIN)

•         has access to the EBT benefits you chose

 

It is important that you know that benefits spent using the alternate card are treated as though you spent them yourself and will NOT be replaced.

 

You must give us written authorization to establish the EBT alternate card holders. You can do this by filling out the Designation of EBT Alternate Card Holder form.  This is also the form that you can use to remove an EBT alternate card holder.

 

The alternate card holder must go to the local office to get the EBT card.

Cash Assistance is Arizona’s Temporary Assistance for Needy Families (TANF) program. It helps families pay for basic needs while helping with job training and finding employment.

Grant Diversion (GD) is:

• A one-time lump sum payment to help people with bills while looking for a job.
• A nonrecurring payment of 3 months of the Cash Assistance (CA) program in a 12 month period.
• For people whose job history shows that they can find a full-time job within 3 months.

 

You must:

• Be eligible for CA to get GD.
• Not be receiving CA.
• Not have received CA benefits in the month you applied.
• Not have received GD benefits in the last 12 months.
• Choose to receive your benefits as GD.

Nutrition Assistance (formerly known as Food Stamps) is Arizona’s federal Supplemental Nutrition Assistance Program (SNAP). The goal of Nutrition Assistance is to help low income families provide adequate nutrition to their families.

The Affordable Care Act (ACA) is a new law that gives you control of your health care and may help to lower your health insurance costs.

Through the ACA, the Federally Facilitated Marketplace has been created to allow customers to shop, compare and buy affordable health insurance plans.  If you apply for AHCCCS Medical Assistance and you are not eligible, you can go to the Marketplace to apply for a tax credit to help with your premiums.

The ACA increases your access to health insurance by creating a Marketplace where you can shop for private health insurance plans.  Health insurance plans (known as Qualified Health Plans) are available through the Marketplace. The ACA also created protections that apply regardless of whether you buy health insurance through the Marketplace. For example, health insurance companies can no longer deny your application or increase your premiums because of your age or health status. 

The ACA also brings changes to AHCCCS Medical Assistance.  The following are some of the changes:

•         Your tax filing status and who you claim as dependents on your taxes may affect whose income is counted on your Medical Assistance application.

•         There will now be coverage for additional low income adults and children households.

For more information about the Affordable Care Act, click here.

You have the following number of days from the date of your decision letter to ask for an appeal:

•          Medical Assistance: 35 days

•          Nutrition Assistance: 90 days

•          Cash Assistance: 35 days

•          Tuberculosis Control: 30 days

If you ask for an appeal after the deadline, you will need to tell us why it is late.

The Jobs Program helps people who are getting Cash Assistance find a job. The free program offers training and support services to help build job skills, and is required for those who are able to work.

The best way to find out if you can get Nutrition Assistance is to apply.  You can also visit our online screener to do a quick check based on your household size before you apply. 

 

Each household has different needs, so this information should only be used as a guide. 

We count the gross income of all the people in your household.  Gross income is the amount of income before deductions like taxes, insurance, etc.  Some situations may change the gross monthly income amount allowed or counted for your household.

 

Nutrition Assistance Gross Monthly Income Eligibility Standard effective October 1, 2016

(130% of the Federal Poverty Level)

 

Household size of:

1, the gross income limit is $1287
2, the gross income limit is $1736
3, the gross income limit is $2184
4, the gross income limit is $2633
5, the gross income limit is $3081

For each additional person add $451

Nutrition Assistance Gross Monthly Income for households that have a disabled or elderly person effective October 1, 2016 

(165% of the Federal Poverty Level)

 

Household size of:

1, the maximum gross income limit is $1634
2, the maximum gross income limit is $2203
3, the maximum gross income limit is $2772
4, the maximum gross income limit is $3342
5, the maximum gross income limit is $3911

For each additional person add $572

The Restaurant Meals Program allows some people to use their Nutrition Assistance benefits to buy hot and prepared meals.  This program is available when everyone in the Nutrition Assistance household is:

•         60 years of age or older,

•         disabled, or

•         homeless.

The program is only available at some grocery store delis and restaurants.  For a list of the restaurants, see Meals Program Restaurants.

Tribal TANF is a program that allows tribal governments the opportunity to develop, establish and administer their own Cash Assistance programs.  The Tribal TANF program provides temporary cash assistance to eligible participants.

Some items that may be bought with Nutrition Assistance benefits include:

• Foods for the household to eat, such as:
  • breads and cereals;
  • fruits and vegetables
  • meats, fish and poultry; and
  • dairy products. 
• Seeds and plants which produce food for the household to eat.

In some areas, restaurants can be authorized to accept SNAP benefits from qualified homeless, elderly, or disabled people in exchange for low-cost meals.

Click here for a list of items that you can NOT buy with your Nutrition Assistance benefits.

The following items can NOT be purchased using Nutrition Assistance benefits:

•        Alcoholic beverages and tobacco.

•        Non-food items such as soap, paper products, cleaning supplies, and cooking utensils.

•        Items used for gardening such as fertilizer, peat moss, and similar products.

•        Items that are not to be eaten by people such as laundry starch, dog and cat food, seeds packaged as bird seed, or decorative dye used to color hard cooked eggs.

•        Vitamins and minerals, in any form.

•        All health aids, such as aspirin, cough drops or syrups, cold remedies, antacids, and all prescription medicines.

•        Hot foods and prepared meals (except when the person is part of the Restaurant Meals Program ). 

Click here for a list of items that you CAN buy with your Nutrition Assistance benefits.

Contact a Health Insurance Marketplace representative:

•         online at https://www.healthcare.gov/contact-us          

•         by phone (24 hours a day) at 1-800-318-2596 (TTY 1-855-889-4325)  

 

You will receive your AHCCCS ID card in the mail 5 to 10 days after you are approved. You can also print a temporary card by going to your Health-e-Arizona Plus account Tools area.

The following tribes operate a Tribal TANF program:

·         Hopi

·         Navajo Nation

·         Pascua Yaqui

·         Salt River Pima

·         San Carlo Apache

·         White Mountain Apache

When you become eligible for Nutrition Assistance:

A QUEST Electronic Benefit Transfer (EBT) card will be mailed to you. This card works like a debit card. Your benefits are put on your EBT card after approval. It can take up to 48 hours for the benefits to appear. You can use your Nutrition Assistance benefits at stores where EBT cards are accepted to purchase eligible food items.

ebtEDGE is a free mobile app for EBT cardholders. You can download ebtEDGE to your phone. ebtEDGE is available in the Apple App Store (iOS) and Google Play Store (Android). Through this secure app, you will be able to see:

Your benefit balances Benefit schedules The last 60 days of transactions made on your card Nutrition Assistance retailer and ATM locations

You will need to enter your EBT card number and PIN to access your account information.

A Health-e-Arizona Plus account is not needed to do the following:

•          Complete a screener to see if you may be eligible for any public assistance programs

•          Find an office near you where you can apply or get help applying for benefits

•          Print a blank application from the Forms section of the Help Center.

•          Link to a website where you can register to vote

•          Get information about other help in your community

A Health-e-Arizona Plus account is needed to do the following:

•          Apply for public assistance programs

•          Choose someone to represent you in the application process

•          Be told when additional information is needed

•          Ask for an appeal when you disagree with a decision or it takes too long to make a decision on your case

•          Get help verifying your information

•          Refer your application to the Health Insurance Marketplace to see if you can get a tax credit to help pay for insurance coverage

•          Provide information

•          See and print letters about your case

•          Set your account so that letters about your case are not sent by U.S. Mail (paperless)

•          Print temporary AHCCCS Health Insurance cards

•          Renew benefits

•          Report a change

•          Ask for help while you are filling out the application

•          See and make changes to an application completed for you by someone else (e.g. a Community Assistor or someone you chose to represent you)

•          See the status of your case

•          See alerts and reminders

An application may be completed by you or anyone you choose who knows or can get the information needed to complete the application for you and your household members.  You can use this application to apply for anyone in your household, even if they already have benefits, including health insurance.

Your household includes:

·         Your spouse, if married

·         Your children under age 22 who live with you

·         Your partner who lives with you (but only if you have a child together who needs health insurance or Cash Assistance)

·         People you claim on your income tax return even if they do not live with you

·         Relatives in your care who are under the age of 19 and live with you

·         People who you live with that purchase and prepare food with you

We recommend that you complete an application for benefits by:

 

Going online to www.healthearizonaplus.gov              

•         For Medical Assistance applications, you might get a decision right away.

•         When you apply online, HEAplus will ask you follow-up questions.

•         When you submit a paper application, we have to send you a letter to ask you any follow-up questions. 

•         Applying online is the fastest way to get your application into HEAplus.

•         You are here now. Click here to start an application! 

 

You can also complete an application by:

•         Visiting a Community Assistor 

•         Going to your local Department of Economic Security / Family Assistance Administration (DES/FAA) office to use a computer kiosk (where available)

 

You can also print a blank application from the Forms section of the Help Center.  Submit the paper application:

•         Through mail:

PO Box 19009

Phoenix AZ 85005

•         In person

Official business days and hours:

Monday through Friday 8:00 AM – 5:00 PM (Arizona Time)

Closed State Holidays and for Work Furloughs

State Holidays:

New Year’s Day – January 1

Martin Luther King Jr. / Civil Rights Day - Third Monday in January

President’s Day – Third Monday in February

Memorial Day – Last Monday in May

Independence Day – July 4

Labor Day – First Monday in September

Columbus Day – Second Monday in October

Veterans Day – November 11

Thanksgiving Day - Fourth Thursday in November

Christmas Day – December 25

Click here to go to the screening tool.

There are several ways for you to give us the needed documents:

• Online: www.healthearizonaplus.gov Select the following links for HEAplus Tip Sheets for directions:
  • Uploading Documents to Health-e-Arizona Plus
  • E-mailing Documents to Health-e-Arizona Plus
  • Faxing Documents to Health-e- Arizona Plus
• Mail: PO Box 19009,
  Phoenix, AZ 85005-9009
• In person: To find an office near you:
  • Select this link for AHCCCS locations
  • Select this link for DES/FAA locations
  • Call 1-855-HEA-PLUS (1-855-432-7587)

Choose the link below for directions for uploading documents to Health-e-Arizona Plus.

Uploading Documents to Health-e-Arizona Plus

The representative is someone that you pick to help with the application process.  The representative needs to know or be able to get the information to complete the application process for you and your household members.  To pick a representative, a form must be completed and signed.

For Nutrition Assistance (NA) applications: State employees who are involved in issuing  NA or retailers who accept NA, may only be a representative for NA when authorized in writing by the Region Program Manager. 

You (the applicant) are responsible for ALL information provided on the application and stated at the interview by your representative.  Both you and your representative can be held legally responsible for giving false information and can be put in jail for fraud.

For EBT purposes see FAQ: "What is an EBT Alternate Card Holder?"

By law, you must give us a Social Security Number (SSN) for each person applying for benefits or show proof you have applied for one.  Immigrants who are not legally able to get an SSN do not need to give us one. 

 

Giving us an SSN for someone who does not want benefits is optional.  However, not giving us an SSN may keep us from getting information for you and slow down the application process.

Choose the link below for directions for faxing documents to Health-e-Arizona Plus.

Faxing Documents to Health-e-Arizona Plus

You do not need to give us information about citizenship and immigration status for any person who is not applying for benefits.  However, to complete the application process, you may need to give us other information about them such as income and resources.  

To get the most help, you need to give us information about citizenship and immigration status for each person who is applying. 

For Nutrition Assistance and Cash Assistance:

Giving us the citizenship or immigration status for each person who is eligible for benefits allows us to include them in the benefit amount.  If you do not give us this information, it will not affect the eligibility of the people who have given us proof of their citizenship or immigration status.  However, it may affect the benefit amount. 

For AHCCCS Medical Assistance:

If you do not give us your immigration status information, you may only be able to get emergency medical services.

If you are not applying for any benefits or if you chose not to provide citizenship or immigration information, we will not try to find out this information from U.S. Citizenship and Immigration Services (USCIS).  We will not report you, your family, or a household member to U.S. Immigration and Customs Enforcement (ICE) unless you inform us that you, a member of your family, or a household member is not lawfully residing in the U.S. 

Under federal law, certain non-citizens such as refugees or political asylees may qualify for Medical Assistance, Nutrition Assistance, and/or Cash Assistance.  For those non-citizens, USCIS guidelines state that use of these benefits will not affect your ability to become a Lawful Permanent Resident.

Choose the link below for directions for e-mailing documents to Health-e-Arizona Plus.

E-mailing Documents to Health-e-Arizona Plus

You can report changes through any of the following:

 

Online:     https://www.healthearizonaplus.gov/

 

Phone:     (855) HEA-PLUS (432-7587)

 

Mail:         P.O. Box 19009

                 Phoenix, AZ 85005

You will get a letter when it is time to renew your benefits. This letter:

• Gives you information that you may need to confirm, and
• Tells if you need to do anything to complete the renewal.

It is easiest to renew your benefits when you have a Health-e-Arizona Plus (HEAplus) account. When you login to your account, HEAplus will remind you to complete the renewal. Review the information and answer the questions.

If you do not have a HEAplus account, you can turn in the completed and signed renewal letter or application by:

• Mail: PO Box 19009, Phoenix, AZ 85005
• Fax using the HEAplus Fax Cover Sheet attached to the renewal letter. The fax coversheets have a barcode that identifies your application.
• Calling toll-free 1-855-HEA-PLUS (1-855-432-7587).
• Going to an eligibility office.

If you turn in an application more than 60 days before it is time for your renewal, the application will be considered a change. You will still need to complete the renewal process when it is time to renew. If you do not complete the renewal, your benefits will stop.

You can request a voluntary withdrawal at any time to stop getting benefits. However, if there has been a change in your household, you may still be eligible for benefits that can help you and your family. Report the change to find out if you and your family are still eligible. Possible changes could be, but are not limited to, the following:

  
• Started a new job
  
• Income increased
  
• Now have private health insurance
  
• Someone moved in or out of your home

AHCCCS Medical Assistance – You can request that your benefits be stopped in the following ways:

  
• Use your HEAplus account.
  1. If you submitted your Medical Assistance application through your HEAplus account, log into your account.
  2. Click on the “Voluntary Withdrawal” link in the menu on the left side of your home page.
  3. Read the pop-up message, then click on the “Voluntary Withdrawal” button if you want to continue.
  4. Follow the instructions to select an application and the persons whose benefits should be stopped. Tell us if you want the benefits stopped immediately or at the end of the month.
  5. Submit the withdrawal to stop getting benefits. When you are done, you will see a Voluntary Withdrawal Summary screen that confirms you have completed the process.
  
• Call HEAplus Customer Support at 1-855-HEA-PLUS (432-7587). An agent can help you submit your request.
  
• Mail a written, signed request to PO Box 19009, Phoenix, AZ 85005. Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, the names of the persons included in the voluntary withdrawal request, and if you want benefits to stop immediately or at the end of the month.
  
• Fax a written, signed request to 1 (844) 680-9840 (outside Maricopa county) or (602) 257-7031 (area codes 480, 602, 623). Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, the names of the persons included in the voluntary withdrawal request, and if you want benefits to stop immediately or at the end of the month.
  
• Go to a DES/FAA office to submit your request verbally or in writing. For the office nearest you, click on “Find Someone to Help” in the Help Center. Then click on “Find State Eligibility Offices.” Enter your ZIP Code, and click on “Search.”

Nutrition Assistance or Cash Assistance – You can request that your benefits be stopped in the following ways:

  
• Call HEAplus Customer Support at 1-855-HEA-PLUS (432-7587). An agent can help you submit your request.
  
• Mail a written, signed request to PO Box 19009, Phoenix, AZ 85005. Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Fax a written, signed request to 1 (844) 680-9840 (outside Maricopa county) or (602) 257-7031 (area codes 480, 602, 623). Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Go to a DES/FAA office to submit your request verbally or in writing. For the office nearest you, click on “Find Someone to Help” in the Help Center. Then click on “Find State Eligibility Offices.” Enter your ZIP Code, and click on “Search.”

To file a complaint, call 1-855-HEA-PLUS (432-7587). A complaint can be filed when you want to make a complaint about things such as:

•          general complaints

•          office conditions

•          office staff

If you do not agree with a delay or a decision about your benefits, you can file for an appeal. For more information about appeals see the following FAQs:

"What if I do not agree with the delay or decision?"

"How do I ask for an appeal?"

"What is the deadline to ask for an appeal?"

"What happens after I ask for an appeal?"

"What happens at the appeal?"

"Can I keep getting benefits while I wait for an appeal?"

Medical Assistance:

You can apply just for the child.  Your income may or may not be considered depending on the medical program you qualify for.

 

Nutrition Assistance:

You cannot apply just for the child.  You and your household must be included with the child. Income for the entire household must be considered.

 

Cash Assistance:
You can apply just for the child.  However, income for anyone taking care of the child being applied for will be considered.  This includes income from a spouse and any minor children in the home.

During the appeal hearing, those attending will be able to present information about the case.

A judge will listen to all sides and may ask some questions, before making a decision.

The appeal hearing is held in person or by telephone. The following people may attend:

•          The applicant

•          The applicant’s representative

•          Legal counsel

•          The Administrative Law Judge

•          An AHCCCS worker

•          A Department of Economic Security (DES) worker

We send you letters when there is something you need to know about your benefits or to ask you for more information.  You can view them in your Health-e-Arizona Plus account.  Your homepage will show when you have an unread letter. 

We will send you letters when:

·         Information is needed from you

·         You need to take an action

·         It is time to renew your benefits

·         We made a decision about your benefits (such as approvals and denials)

·         We made a change to your benefits (such as stopping, decreasing, or increasing)

·         Something has happened that will affect your benefits (such as missing an interview)

·         There is general information about your benefits.

It is important that you read each letter and follow the directions.

We will send you letters by U.S. Mail unless you choose to go paperless.  If you go paperless, you will be alerted by e-mail and/or text that you have a new letter in Health-e-Arizona Plus. While you are logged into Health-e-Arizona Plus, click on “Manage My Alerts and Notifications” in the tool bar to make these choices.

Letters we sent to you have been returned by the U.S. Postal Service.  Letters could have been returned for any of the following reasons:

·         The post office may not be able to deliver your mail because your name is not on the mailbox

·         The post office cannot deliver mail because your mailbox is broken or missing

·         Your address is wrong in our system

 

If you are having issues with getting letters at your mailing address, you can choose to get letters online in your Health-e-Arizona Plus account.

Check Health-e-Arizona Plus to make sure your mailing address is correct.

 

You must give us your current residential address, including any apartment number.  If you have a separate mailing address, give us both.

It is important to keep your address current in case information needs to be sent to you. Changing your address can be done in one of the following ways:

•         Right now online: http://www.healthearizonaplus.gov

•         By phone: 

           1-855-HEA-PLUS (432-7587)

•         By mail:     

            PO Box 19009

      Phoenix AZ 85005

 

We will send you letters by U.S. Mail. If you have a Health-e-Arizona Plus account, you can view most letters we send you in your account. You can also choose to go paperless. If you go paperless, you will be alerted by e-mail and/or text that you have a new letter in your Health-e-Arizona Plus account. (See FAQ "What do I need to know about letters?" for more information)

You can have your letters sent to the address of someone you know, such as a friend or relative, or someone who is willing to accept mail on your behalf. If you choose to do this, it is important that you add their name to “In Care Of.” Otherwise, your mail may be returned and your benefits may be stopped.

You can also sign up for a PO Box or General Delivery Service with a United States Post Office. The General Delivery post office will only hold mail for 10 days unless you sign up for 30-day service. You can sign up using a valid ID and a “General Delivery” form at a Post Office. The form is also available in Health-e-Arizona Plus by clicking on “Help Center” and then “Forms.” For more information about General Delivery service, call 1-800-ASK-USPS (1-800-275-8777).

To find the location of the nearest General Delivery post office near you, complete the following:

• Click here to go to the USPS website, and enter “General Delivery” in the “Street Address” field. Then enter the ZIP Code for where you live in the “ZIP Code” field, and click on the “Find” button.The City and ZIP Code (with the Plus 4 as “9999”) for the closest General Delivery post office displays.
• Click here to get the address and map location for the General Delivery post office by completing the following:
1. In the “City and State, or ZIP Code” field, enter the General Delivery ZIP Code that you found.
2. Select “Post Offices” from the “Location Types” drop-down.
3. Click the “Search” button.
4. The General Delivery post office address should display first in the list of “Search Results.” Click on the post office name link to see more information about the post office.

For the Medical Assistance Program: 

The Health-e-Arizona Plus application date is the date the signed application was submitted.

 

For Cash Assistance and Nutrition Assistance: 

When the application is submitted DURING official business hours, the date of application is the date the signed application was submitted.

 

When the application is submitted AFTER official business hours, the date of application is the NEXT official business day.

 

            Official business days and hours:

 

Monday through Friday 8:00 AM – 5:00 PM (Arizona Time)

Closed State Holidays and for Work Furloughs

                State Holidays:

New Year’s Day – January 1

Martin Luther King Jr. / Civil Rights Day - Third Monday in January

President’s Day – Third Monday in February

Memorial Day – Last Monday in May

Independence Day – July 4

Labor Day – First Monday in September

Columbus Day – Second Monday in October

Veterans Day – November 11

Thanksgiving Day - Fourth Thursday in November

Christmas Day – December 25

All information that you have entered in your application will be saved for 10 days.

 

After you log back in, click on the application number link found on your homepage.  It will take you back to where you stopped your application.  From there you can finish and submit it. 

Contact the FIS Automated Response Unit at 1-888-997-9333 or TTY (Telecommunications Relay Service for Hearing/Speech Impaired) at 1-800-367-8939.

Report lost, stolen or damaged cards immediately to have your card deactivated so no one else can use it. You can report the card lost, stolen or damaged by contacting the FIS Automated Response Unit at 1-888-997-9333 or TTY (Telecommunications Relay Service for Hearing/Speech Impaired) at 1-800-367-8939.

If you lose your EBT card you may have to pay for a new one. This amount will be taken out of your benefits at the time of replacement.

If you request more than two EBT replacement cards in a 12-month period, you may be required to contact DES and explain the reasons for the card replacements.

When using Internet Explorer, click on the REFRESH button.
When using Google Chrome, click on the RELOAD THIS PAGE button.
When using FireFox, click on the RELOAD CURRENT PAGE button.

If that does not work, do the following:

• Close your Internet browser
• Reopen the browser
• Log back into Health-e-Arizona Plus

If you keep getting this error message, please call support at 1-855-HEA-PLUS (432-7587).

When applying for help with your health insurance costs, an interview is not needed.  When applying for Nutrition Assistance or Cash Assistance you or your representative must complete an interview in person or by phone.  If you need special accommodations for an interview, please contact customer service at (855) HEA-PLUS (432-7587).

 

Additional information regarding Medical Assistance, Nutrition Assistance, and Cash Assistance can be found at any of the following:

·         The AHCCCS website at www.azahcccs.gov

·         The Department of Economic Security (DES) Family Assistance Administration (FAA) website at https://des.az.gov/services

·         Arizona’s Eligibility Policy Manual

Additional information regarding the new health care changes can be found at https://questions.cms.gov/faq.php?id=5005&rtopic=1993

Also, you can contact a Customer Support Specialist by:

·         Calling during normal business hours at 855-HEA-PLUS (432-7587).

·         Typing your question (chatting) during normal business hours. 

        This can be done from any page in Health-e-Arizona Plus by clicking on “Help Center” at the top of the page and then clicking on chat.

·         Sending an e-mail.

        This can be done from any page in Health-e-Arizona Plus by clicking on “Help Center” at the top of the page and then click on e-mail.

To report member fraud for AHCCCS Medical Assistance:

• Go to www.azahcccs.gov/fraud/ReportFraud/
• From Area Codes 602,623 and 480, call 602-417-4193
• From all other Area Codes, call (888) ITS-NOT-OK or (888) 487-6686
• Send e-mail to AHCCCSFraud@azahcccs.gov

To report provider fraud for AHCCCS Medical Assistance:

• Go to www.azahcccs.gov/fraud/ReportFraud/
• From Area Codes 602,623 and 480, call 602-417-4045
• From all other Area Codes, call (888) ITS-NOT-OK or (888) 487-6686
• Send e-mail to AHCCCSFraud@azahcccs.gov

To report fraud for Nutrition Assistance and Cash Assistance:

• Go to des.az.gov/how-do-i/report-suspected-fraud
• Call the Automated Fraud Hotline at (800) 251-2436

To report Commercial Health Insurance fraud:

• Go to www.azinsurance.gov/fraud.html
• Call (602) 364-2140

You can register to vote or update your voter registration by going to the Arizona Secretary of States website:

https://azsos.gov/elections/voting-election

At any time in Health-e-Arizona Plus, you can click on Register to Vote on the tool bar at the top of the screen.

Health-e-Arizona Plus cannot accept an incomplete application for Medical Assistance, but you can submit an incomplete application online for Nutrition Assistance and Cash Assistance.

We need a completed application before we can know if you are eligible for benefits. An incomplete application must contain at least your name, address, signature, and the date you signed it in order to save the date of your application.

An incomplete paper application may be submitted for all programs.

If you have applied and you are waiting for a decision, you can choose to voluntarily withdraw the application. Your application will be denied based on your voluntary withdrawal request.

AHCCCS Medical Assistance – You can request that your application be withdrawn in the following ways:

  
• Use your HEAplus account.
  1. If you submitted your Medical Assistance application through your HEAplus account, log into your account.
  2. Click on the “Voluntary Withdrawal” link in the menu on the left side of your home page.
  3. Read the pop-up message, then click on the “Voluntary Withdrawal” button if you want to continue.
  4. Follow the instructions to select an application and the person(s) you are withdrawing the application for. The effective date will be immediate.
  5. Submit the withdrawal. When you are done, you will see a Voluntary Withdrawal Summary screen that confirms you have completed the process.
  
• Call HEAplus Customer Support at 1-855-HEA-PLUS (432-7587). An agent can help you submit your request.
  
• Mail a written, signed request to PO Box 19009, Phoenix, AZ 85005. Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Fax a written, signed request to 1 (844) 680-9840 (outside Maricopa county) or (602) 257-7031 (area codes 480, 602, 623). Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Go to a DES/FAA office to submit your request verbally or in writing. For the office nearest you, click on “Find Someone to Help” in the Help Center. Then click on “Find State Eligibility Offices.” Enter your ZIP Code, and click on “Search.”

Nutrition Assistance or Cash Assistance – You can request that your application be withdrawn in the following ways:

  
• Call HEAplus Customer Support at 1-855-HEA-PLUS (432-7587). An agent can help you submit your request.
  
• Mail a written, signed request to PO Box 19009, Phoenix, AZ 85005. Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Fax a written, signed request to 1 (844) 680-9840 (outside Maricopa county) or (602) 257-7031 (area codes 480, 602, 623). Please include the following information: Your name, your DES Case Number or the HEAplus Application ID Number, and the names of the persons included in the voluntary withdrawal request.
  
• Go to a DES/FAA office to submit your request verbally or in writing. For the office nearest you, click on “Find Someone to Help” in the Help Center. Then click on “Find State Eligibility Offices.” Enter your ZIP Code, and click on “Search.”

Coverage for prior medical expenses is only for medical services received in the three months before the application month. It is available to persons who:

• Were under age 19 when the service was received; or
• Were pregnant when the service was received; or
• Had a pregnancy end in the past five months and were in their postpartum period when the service was received.

The person must also meet all other eligibility requirements for the month in which the service was received. The services received must be covered under AHCCCS Medical Assistance.

Even if you have already paid the bill, answer the question about prior medical expenses on the application. We will see if you are eligible for coverage during those months when we review your application.

If you receive a letter asking you to complete a fraud investigation for Cash Assistance, you must cooperate. If you do not cooperate your benefits may be stopped. You will receive a notice at least ten (10) days before the effective date your benefits will stop.

AHCCCS will not be mailing out 1095-B forms this year. The 1095-B is not required for this tax year. If you, someone in your household, or your tax dependents received AHCCCS medical assistance anytime during this year, and would like to receive a copy of your 1095-B form, you may request a copy through any of the following:

• E-mail address: mcdumemberescalation@azahcccs.gov
• Phone number: 1-833-810-4200 (English) or 1-833-810-4300 (Spanish)
• Mail: 801 E Jefferson St MD 3400 Phoenix, AZ 85034

A copy of your 1095-B form will be mailed to you within 30 calendar days of your request.

For tax related questions, tax information, and IRS forms, visit http://www.irs.gov. AHCCCS Medical Assistance (except Federal Emergency Services and Medicare Savings Program) is considered Minimum Essential Coverage under the Affordable Care Act. For more information about Minimum Essential Coverage, visit http://www.irs.gov/Affordable-Care-Act.
There is no fee for not having Minimum Essential Coverage for 2019.

People who receive health insurance coverage through the Health Insurance Marketplace (also known as an Exchange) will receive Form 1095-A. This form will not come from AHCCCS. Please contact the Health Insurance Marketplace if you have any questions about Form 1095-A by calling 1-800-318-2596 (TTY: 1-855-889-4325).
People who receive health insurance coverage through an employer will receive a 1095-B form or 1095-C form. These forms will not come from AHCCCS. Please contact the employer if you have questions about health insurance coverage through an employer.
If you, someone in your household, or your tax dependents, received AHCCCS medical assistance anytime during the year and would like to receive a copy of your 1095-B form, you may request a copy through any of the following:

• E-mail address: mcdumemberescalation@azahcccs.gov
• Phone number: 1-833-810-4200 (English) or 1-833-810-4300 (Spanish)
• Mail: 801 E Jefferson St MD 3400 Phoenix, AZ 85034

A copy of your 1095-B form will be mailed to you within 30 calendar days of your request.
Call the phone number above if you believe the information you received on the 1095-B form is incorrect or someone is missing.

Medicare Part A is insurance through the Social Security Administration. This insurance covers hospital care, limited skilled nursing facility fees, hospice fees, lab tests, surgery, and limited home health care. Medicare is usually free but some people may be required to pay a premium.

Conditional Medicare Part A is for customers who are:

• Not eligible for premium free Medicare Part A and
• Unable or unwilling to pay the Medicare Part A premium.

1. Apply for Conditional Medicare Part A with the Social Security Administration.
2. Be approved for Conditional Medicare Part A.
3. After being approved for Conditional Medicare Part A, apply for QMB through AHCCCS. The Conditional Medicare Part A approval may take a few days to show in our system.
4. Upon QMB approval, AHCCCS will notify Social Security.
5. Social Security will enroll you in Medicare Part A. AHCCCS will pay the premiums.

It can take up to 45 days to process your QMB application.You will get a letter when a decision has been made.

It may take up to 3 months after being approved for QMB to see an increase in your checks. Social Security will notify you when the change has taken place.