AHCCCS Health Insurance (Medical Assistance)
The Department of Economic Security (DES) Family Assistance Administration (FAA) determines eligibility for some Arizona Health Care Cost Containment System (AHCCCS) Health Insurance programs.
These are the four health insurance programs under AHCCCS:
- Medicaid - for adults and children with limited income.
- KidsCare* - for children under age 19 who are uninsured and have income higher than the Medicaid limit.
- Arizona Long Term Care System (ALTCS)* - for adults and children who need long term care services like services provided by a nursing home. Services may be provided in the person's own home.
- Medicare Cost Sharing*- for adults and children who have or could have Medicare.
*Eligibility determined by AHCCCS.
The medical insurance coverage provided by AHCCCS includes doctor’s office visits, physical exams, immunizations, prenatal care, hospital care and prescriptions. Learn more about services provided.
Many individuals who qualify for medical assistance are also likely having difficulty meeting other basic needs - such as food and shelter. While applying for Medical Assistance the same application may be used to apply for Nutrition Assistance and Cash Assistance. Therefore, families only have to provide information once in order to determine if they are eligible for multiple types of services that may enhance their family's well-being.
Costs & Fees:
There are no fees for applying for medical assistance. Some medical assistance programs may require the participant to make a co-payment when receiving medical services. Some co-payments are mandatory; the medical provider may not provide service if the mandatory co-payment is not paid. However, if you do not have mandatory co-payments the provider may ask for the co-payment, but cannot deny service when you are unable to pay.
You will receive a letter indicating whether you have mandatory co-payments. The letter also includes the services which require co-payment and amount of the co-payment. The co-payment may be waived by the medical provider.
The KidsCare program requires payment of monthly premiums. If you need to pay a premium AHCCCS will send a letter to you before your first premium is due.
Myths & Facts
|Myth: Individuals and families who have health insurance coverage are not eligible for medical assistance.
||Myth: You have no choice in health plan or physician when you have medical assistance coverage.
|Fact: Individuals and families who are covered by health insurance may be eligible for AHCCCS medical coverage when they meet all other program criteria. AHCCCS then becomes the secondary provider of medical coverage.
||Fact: The individual may select a health plan when applying for medical assistance. When they are determined eligible for medical assistance, the health plan will provide them with information on how to select their primary care provider.