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User Agreement

ALTCS
Please read this user agreement. Check the box, then click on ‘Accept’ to continue  
Read this User Agreement carefully. This agreement is between you and the organizations that have made Health-e-Arizona Plus available to you. For information on Terms and Conditions, click here: Terms and Conditions You may only use Health-e-Arizona Plus if you agree to the following:

1. Health-e-Arizona Plus is licensed which means you cannot change, copy, or republish any part of it.

2. You may not use this software for anything other than to apply for public benefits in Arizona, or to update information.

3. Your answers to all questions in the application and any information you give us must be truthful and complete. This includes all information that you give to AHCCCS, DES, or their contractors whether through Health-e-Arizona Plus or by other means. When you submit the application, the Health-e-Arizona Plus system will ask you to confirm under penalty of perjury that the statements you made are true and correct to the best of your knowledge, and that you have not held back any information.

4. You may set up an account to apply for public benefits and to get into your own application and eligibility information that you enter for yourself and the other members of your family/household or as an authorized representative of other people or families/households.

5. If you abuse the system (for example, you do not tell us about a job you have so that you could get benefits that you are not eligible for) or try to use the system for any other purpose, we will terminate your account and you may be subject to criminal prosecution.

6. Health-e-Arizona Plus stores and shows confidential information. You are responsible for making sure this confidential information is not being shared with others. When you log into Health-e-Arizona Plus, you must use a computer that has a secure connection. For example, a computer firewall is recommended. Keep your password confidential.

By clicking the 'Accept' button, you agree to this User Agreement. If you click the 'Decline' button, you will not be able to set up an account or use Health-e-Arizona Plus to apply for benefits.
 
 
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Help and Hints

   
About this page
This page contains the user agreement and the link to the terms and conditions of using this website.
You must agree to these terms to create an account.
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About this page
This page contains the user agreement and the link to the terms and conditions of using this website.
You must agree to these terms to create an account.

How to complete this page
If you agree:
  • Check the box indicating that you have read and agree to the terms and conditions of this User Agreement.
  • Click ‘Accept’ to move to the next page.
    If you do not agree, click ‘Decline’ to end the account creation.
  • You are saving and closing the application, you can come back later.
       
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  • {0} is NOT eligible for HPE – Received HPE in last 24 months
  • {0} is NOT eligible for HPE – Age 65 or older and no minor children
  • {0} is NOT eligible for HPE – Receiving Medicare and no minor children
  • Presumptive Eligibility Alert!

    Warning!

       

    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.


       
    Return To Full Application Continue to HPE

    Stop

       

    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.


       
    Return To Full Application Continue to HPE

    Warning:Some persons cannot qualify for Hospital Presumptive Eligibility

       

    Warning:No one in this application can qualify for Hospital Presumptive Eligibility

       

    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.


       
    Return To Full Application Continue HPE for other persons
    Ok
       
       
    Yes
    No