Medicaid / AHCCCS
Medicaid is a federal program that helps people and families with low incomes get medical care. Each state can choose to have a Medicaid program. Arizona’s Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS).
AHCCCS helps eligible families and individuals in Arizona get health care.
They work with different health plans to provide services like prescriptions, office visits with medical providers, lab and x-ray services, hospital stays, medical supplies and equipment, and behavioral health care.
For kids and young adults under 21, AHCCCS offers even more services.
This includes Early Periodic Screening and Diagnostic Services (EPSDT), which covers check-ups, vision, dental, hearing services, and more. You can find a full list of EPSDT services in the Medicaid Act.
AHCCCS has many health care programs with different rules for who can join and what they cover. Here are examples:
Health insurance for adults aged 19 to 64 who do not qualify for other AHCCCS programs.
Health insurance for kids under 19 who are not eligible for other AHCCCS programs. Families with kids in KidsCare must pay monthly premiums based on their income.
Long term care services for adults and children that need help with daily activities like bathing, dressing, and moving around.
Helps pay for Medicare premiums, copays, and deductibles. There are three levels of coverage, and how much AHCCCS pays depends on your income.
Health insurance for workers with disabilities under 65. This may include ALTCS services.
Health care for young adults aged 18-26 who were in foster care and had AHCCCS when they turned 18. Enrollment is automatic for these young adults.
Special health care for women diagnosed with breast or cervical cancer or pre-cancerous cervical lesions.
To see all the AHCCCS programs, their rules, and what they cover, visit the AHCCCS website. The Arizona Department of Economic Security (DES) helps AHCCCS with some programs, so you might talk to AHCCCS, DES, or both if you apply.
Eligibility
AHCCCS runs Medicaid programs in Arizona. Federal Medicaid laws and regulations set the eligibility for Medicaid programs like AHCCCS.
Each program has its own rules, but there are some things that apply to all programs:
- You must live in Arizona.
- You must be a U.S. citizen or have a qualified immigration status.
- You will need a Social Security number (or proof of application).
- You must meet certain income and household size requirements.
You need to live in Arizona to get Medicaid. You do not need to live in Arizona for a specific time.
You meet the residency requirement if:
- Arizona is your permanent home.
- You just moved to Arizona.
- You temporarily moved away but plan to return.
To prove you live in Arizona, you can give AHCCCS or DES:
- Proof of address like a lease agreement or utility bills;
- State issued identification like a driver’s license or ID card;
- A residency statement from a non-relative who does not live with you. This statement must state where you live and who you live with. The person must date and sign it with their address and phone number.
How to apply
To apply for AHCCCS health programs, you must complete an application. The type of AHCCCS program you apply for may change how you apply, where you apply, and what type of information you are required to provide with your application.
Please select the AHCCCS program that best fits your needs:
You must give AHCCCS or DES all the information they ask for. If you do not, they might deny or stop your benefits.
Keep copies of everything you give AHCCCS or DES.
Keep proof that you gave them documents, like date-stamped copies, fax confirmations, or online confirmation printouts. If they deny your application because they say they didn’t get what they asked for, your copies will help you prove you sent it.
After you apply
After your application is evaluated by AHCCCS or DES, they will notify you in writing if you are approved or not approved to join a Medicaid program.
AHCCCS or DES may send this notice to your HEAplus account, by mail, or by email.
If you are approved to join an AHCCCS program, the notice you will receive will include:
- The name of the person(s) approved for AHCCCS.
- The program you are approved for.
- How long you will participate in the program.
- Instructions on how to choose an AHCCCS health plan.
- How to report changes, like if you move, your income changes, or if your household size changes.
If you are not approved to join an AHCCCS program, AHCCCS or DES will send you a notice. Some reasons they might deny your application are:
- You do not meet the eligibility conditions for an AHCCCS Medical Assistance (MA) program.
- There is not enough information included with your application to decide if you are eligible, even after trying to get the information from you or other sources.
- AHCCCS sends you mail that is returned by the post office, and they cannot find out where you live.
- You are an inmate and will not be released before your application is processed.
Carefully read all communications from AHCCCS and DES. There are deadlines that affect your right to medical assistance.
If you disagree with a decision
If you disagree with a decision AHCCCS or DES makes about your application or benefits, you usually have the right to ask someone to review the decision. This review is called an appeal.
AHCCCS or DES will send you notice about their decision, which might come to your HEAplus account, by mail, or by email. The notice will tell you the deadline to appeal. If you get the notice by mail, you have 35 calendar days from the date on the notice to appeal. You can also appeal if they do not decide about your application within the required time.
You can ask for an expedited (faster) appeal if you have a statement from your medical provider. AHCCCS or DES must resolve an expedited appeal no later than seven working days after getting it.
The statement must say:
- You have a procedure or treatment scheduled, or you cannot schedule one because you do not have health care coverage.
- You do not have health insurance that will cover most of the treatment cost.
- Your life, physical or mental health, or ability to function is at serious risk if you must delay treatment for 90 days (about 3 months) or less from the date of your appeal request.
If you want to keep your benefits during the appeal process, you must appeal within 10 days (about 1 and a half weeks) of the date on the notice or before your medical assistance ends.
If you lose your appeal, you may have to pay back any benefits you received during the appeal process.
You usually cannot appeal decisions based on changes in law. For example, if the federal government changes the law and it affects your benefits or eligibility, you cannot appeal that change.
How to appeal
There are several ways you can appeal a decision made by DES or AHCCCS. Choose the way that is easiest for you:
ALTCS and KidsCare appeal requests only go to AHCCCS. For AHCCCS decisions on ALTCS and KidsCare, send your appeal request to AHCCCS online, by mail, fax, phone, or in-person.
You do not need to use special language in your appeal. Each decision letter includes a pre-printed “Appeal Request Form” or “I Am Asking For A Hearing” section. You do not have to use the form or letter to request an appeal. You can write your own letter that explains why you disagree with the decision.
Make sure to include:
- The reason for your appeal
(e.g. “I disagree with…”) - The date of the notice you want to appeal
- Your DES case number or AHCCCS application/member number
Keep proof of how and when you appeal. This will help you prove you appealed before the deadline in case AHCCCS or DES loses your appeal or does not process it. If you appeal by phone, make a note of the date, time, and who you talked to.
What to expect after your appeal is filed
After you appeal, AHCCCS or DES will schedule a Fair Hearing with an Administrative Law Judge (ALJ).
An ALJ is like a judge for your appeal. The ALJ does not know about your case until the hearing. The ALJ learns about it from you and AHCCCS or DES.
You will get a notice in the mail before the hearing. The notice will tell you:
- The date and time of the hearing;
- Issues the ALJ will talk about;
- The legal rules; and,
- Your hearing rights.
Hearings are usually by phone unless you ask for an in-person hearing. The notice will tell you how to ask for an in-person hearing. It will also explain how to send proof to the ALJ and how to have witnesses speak.
Appeals of an AHCCCS hearing decision
If you or the agency fair hearing coordinator disagrees with the AHCCCS Director’s decision, you can ask for a rehearing from the AHCCCS Director. You can also appeal to the superior court.
You can ask for a rehearing or review for any of these reasons:
- There was an irregularity in the hearing or appeal proceedings that deprived you of a fair hearing.
- There was misconduct by the eligibility office or the agency.
- There is newly discovered evidence that you could not have found before the hearing.
- There was prejudice in the decision.
- The decision was not justified by the evidence or is against the law.
- One of the parties had a good reason not to appear at the hearing.
The rehearing process involves a review of the hearing file and other written documents from you or the agency. Either party can object to the petition, and sometimes there may be more testimony.
After reviewing the information, the Director issues a Final Decision.
Appeals of a DES hearing decision
If you disagree with the fair hearing decision, you can ask for a review from the Office of Appeals (OOA) Appeals Board. The Appeals Board may accept or decline a rehearing or review of a case.
If the Appeals Board accepts the review, they will do a review and inform you and the FAA Policy Support Team (PST) of the results. If the OOA Appeals Board decision is not in your favor, you can ask the Appeals Board for another review. If the Family Assistance Administration (FAA) disagrees with the OOA Appeals Board decision, FAA must send a request to the Office of the Attorney General. If the Office of the Attorney General agrees with FAA, they send a request for review to the OOA Appeals Board.
Appealing a decision about your services
Sometimes, an AHCCCS health plan will deny medical supplies, a service, or treatment your doctor prescribed. When this happens, the health plan – not AHCCCS or DES – will send you a written notice. You can appeal this decision. Your appeal will go to the health plan.
There are deadlines that affect your right to medical assistance. You need to carefully read all communications from AHCCCS. The notice will tell you the deadline to appeal and how to do it.
The first level of appeal is an internal review by the health plan.
AHCCCS health plans want to know why the prescribed service is medically necessary. In Arizona, AHCCCS is governed by a law that defines a service as medically necessary if “it is provided by a physician or other licensed practitioner to prevent disease, disability, or other adverse health conditions or their progression, or to prolong life.”
AHCCCS health care plans only have information from the medical provider who sent the request for the medical supplies, services, or treatment.
If you believe your health plan did not have important information when they decided to deny you services or treatment prescribed by your doctor, give them the information with your appeal.
The AHCCCS health plan will review your case. They will decide either to approve the service or keep the original denial. The notice of the appeal decision will tell you how to appeal to the second level.
The second level of appeal is a request for a fair hearing.
You have 30 days to appeal and request a fair hearing. The notice will explain how and where to appeal. The fair hearing happens before an Administrative Law Judge (ALJ). For more details on what happens at a fair hearing, see the section above.
This topic can be complicated. You may want to talk to a legal professional for help.
This website shares general legal information. Some content may be simplified or may not reflect recent changes in law. If you need advice for your specific situation, you should talk to a legal professional.
This content was last updated on Oct 1, 2025.