Arizona Request for an Individuals Health Information
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FAQ
There are several ways for you to give us the needed documents:Online: Select the following links for HEAplus Tip Sheets for directions: Uploading Documents to Health-e-Arizona Plus.Mail: PO Box 19009, Phoenix, AZ 85005-9009.In person: To find an office near you:
Social security benefits are counted for all MA programs as unearned income. Ongoing benefits are paid monthly. For back pay received as a lump sum see MA604.
There are several ways for you to give us the needed documents:Online: Select the following links for HEAplus Tip Sheets for directions: Uploading Documents to Health-e-Arizona Plus.Mail: PO Box 19009, Phoenix, AZ 85005-9009.In person: To find an office near you:
You and your family can usually get AHCCCS if your family's income is at or below 138% of the Federal Poverty Guidelines (FPG) ($17,774 for an individual in 2022, $36,570 for a family of four).
The state's Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS). Depending on your income, you may qualify for free or low-cost coverage through AHCCCS.
You can renew your benefits online with a Health-e-Arizona Plus account. If you'd rather renew in person, call your caseworker, local office, or the Arizona SNAP hotline (1-855-777-8590) to find out how.
MEDICAID APPLICATION DOCUMENTSDRIVERS LICENSE, PHOTO ID CARD, OR PASSPORT.SOCIAL SECURITY CARD FOR APPLICANT, (and spouse if living)RED, WHITE AND BLUE MEDICARE CARD.HEALTH INSURANCE CARDS, PREMIUM AMOUNT STATEMENT.BIRTH CERTIFICATES FOR APPLICANT (Naturalization papers for immigrants) MARRIAGE CERTIFICATE if married.
It must be signed, dated and include that person's address and telephone number. Proof of ALL money your household received from any source last month and this month. Proof that your employment ended and last date paid. Verification of any medical insurance other than AHCCCS.
You can report changes in the following ways:On-line at Health-e-Arizona Plus (HEAplus) for Medical Assistance.On-line at MyFamilyBenefits for Nutrition and Cash Assistance.By calling 1-855-432-7587 or 1-855-HEAplus.By completing the Change Report form and mailing, faxing, or submitting it to your local DES office.
To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, based on the number of people who live in your home. The income limits based on household size are: One person: $17,609. Two people: $23,792.
