Skip to Main Content
Ok Cancel
test
Ok
 
Please wait while we retrieve Application Summary

Minimize

Maximize

Health-e-Arizona Plus Home
Health-e-Arizona Plus
  • Log In | Create Account
  • Font Size:
    A A A A
  • English
     | Español



Explore Options

ALTCS
Screener
Screening Tools

Learn More... Go to Screening Tools
 
 
 
 
 
Close
                 




Logo Great Seal of the State of Arizona
Privacy |  Learn More| SiteMap   | Mission Statement | Non-Discrimination Policies| |
© 2019 AHCCCS. All Rights Reserved - 01
   
Are you sure you want to cancel this application and delete it from the system?
   
Yes
No
   
Please Click [Cancel] to stay on the same Page or Click [Ok] to Save and Close
   
Ok
Cancel
Navigation Alert
Navigation is not allowed from this page
 
Close
   
   

Not sure what to apply for? Screening tools can help you find out the programs you qualifzz for and how to apply.

You are saving and closing the application, you can come back later.
   
Close
  • {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