AHCCCS ELIGIBILITY REQUIREMENTS January 1, 2024
Where to Apply	Eligibility Criteria	General Information	
	Household Monthly Income by
Household Size (After Deductions)1	Resource Limits (Equity)	Social Security #	Special 
Requirements	Benefits	

Coverage for Children	
Children 
Under Age 1	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	147% FPL
	1	$1,845.00
	2	$2,504.00
	3	$3,163.00
	4	$3,822.00
	Add $660 per Add’l person*	N/A	Required	N/A	AHCCCS
Medical Services2	
Children
Ages 1 – 5	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	141% FPL
	1	$1,770.00
	2	$2,402.00
	3	$3,034.00
	4	$3,666.00
Add $633 per Add’l person*	
N/A	Required	N/A	AHCCCS
Medical Services2	
Children 
Ages 6 – 18	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	133% FPL
	1	$1,670.00
	2	$2,266.00
	3	$2,862.00
	4	$3,458.00
Add $597 per Add’l person*	N/A	Required	N/A	AHCCCS
Medical Services2	
KidsCare
Children 
Under Age 19	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	225% FPL 
	1	$2,824.00
	2	$3,833.00
	3	$4,842.00
	4	$5,850.00
Add $1,009 per Add’l person*
	N/A	Required	•	Not eligible for Medicaid
•	Not available to State employees, their children, or spouses
•	$10 - $70 monthly premium covers all eligible children 
	AHCCCS
Medical Services2	

Coverage for Individuals	
Parent & Caretaker Relatives	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	106% FPL
1	$1,331.00
2	$1,806.00
3	$2,281.00
4	$2,756.00
Add $476 per Add’l person*	N/A	Required		AHCCCS
Medical Services2	
Adults	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	133% FPL
	1	$1,670.00
	2	$2,266.00
	3	$2,862.00
	4	$3,458.00
Add $597 per Add’l person*	N/A	Required	•	19 years of age or older
•	Under age 65
•	Not entitled to Medicare
•	Adult’s children must have health insurance coverage
•	Ineligible for any other categorical Medicaid coverage	AHCCCS
Medical Services2	

Coverage for Women	
Pregnant Women	www.healthearizonaplus.gov
or
DES/Family Assistance Office
Call 1-855-HEA-PLUS for the nearest office	156% FPL
1	$1,958.00
2	$2,658.00
3	$3,357.00
4	$4,056.00
Add $700 per Add’l person*
(Limit increases for each expected child)	N/A	Required		AHCCCS
Medical Services2	
Breast & Cervical Cancer Treatment Program	Well Women 
Healthcheck Program
Call 1-888-257-8502 for the nearest office	N/A	N/A	Required	•	Under age 65
•	Screened and diagnosed with breast cancer, cervical cancer, or a pre-cancerous cervical lesion by the Well Woman Health check Program
•	Ineligible for any other Medicaid coverage	AHCCCS
Medical Services2	

AHCCCS ELIGIBILITY REQUIREMENTS February 1, 2024

	Application	Eligibility Criteria	General Information	
	Where to Apply	Household Monthly Income by
Household Size (After Deductions) 1	Resource Limits (Equity)	Social Security Number	Special 
Requirements	Benefits	

Coverage for Elderly or Disabled People	
Long Term 
Care	ALTCS Office
Call 602-417-7000 or
 1-800-654-8713 
for the nearest office	
300% FBR
$2,829 Individual	$2,000 Individual3	Required	•	Requires nursing home level of care or equivalent
•	May be required to pay a share of cost
•	Estate recovery program for the cost of services received after age 55	AHCCCS 
Medical Services2,
Nursing Facility,
Home & Community Based Services, and Hospice	
SSI CASH	Social Security Administration	100% FBR
$943 Individual
$1,415 Couple	$2,000 Individual
$3,000 Couple	Required	•	Age 65 or older, determined to be blind, or have a disability	AHCCCS
Medical Services2	
SSI MAO 	www.healthearizonaplus.gov 
or mail an application to
SSI MAO
801 E Jefferson MD 3800
Phoenix, Arizona 85034	100% FPL
$1,255 Individual
$1,704 Couple	N/A	Required 	•	Age 65 or older, determined to be blind, or have a disability	AHCCCS
Medical Services2	
Freedom to Work	www.healthearizonaplus.gov 
or mail an application to
801 E Jefferson MD 7004
Phoenix, AZ 85034
602-417-6677 
1-800-654-8713 Option 6	250% FPL
$3,138 Individual
Only Earned Income is Counted	N/A	Required 	•	Must be working and either determined to be blind or have a disability
•	Must be age 16 through 64
•	Premium may be $0 to $35 monthly	AHCCCS
Medical Services2	
					+	Need for Nursing home level of care or equivalent is required for Long Term Care (Nursing Facility, Home & Community Based Services, or Hospice)	Nursing Facility,
Home & Community Based Services, and Hospice	

Coverage for Medicare Beneficiaries	
QMB	www.healthearizonaplus.gov 
or mail an application to
SSI MAO
801 E Jefferson MD 3800
Phoenix, Arizona 85034	100% FPL
	$1,255 Individual
	$1,704 Couple	N/A	Required	•	Entitled to Medicare Part A	Payment of
Part A & B premiums, coinsurance, and deductibles	
SLMB	www.healthearizonaplus.gov 
or mail an application to
SSI MAO
801 E Jefferson MD 3800
Phoenix, Arizona 85034	120% FPL
$1,255.01- $1,506.00 Individual
$1,704.01- $2,044.00 Couple	N/A	Required	•	Entitled to Medicare Part A	Payment of
Part B premium	
QI-1	www.healthearizonaplus.gov 
or mail an application to
SSI MAO
801 E Jefferson MD 3800
Phoenix, Arizona 85034	135% FPL
$1,506.01-$1,695.00 Individual
$2,044.01-$2,300.00 Couple	N/A	Required	•	Entitled to Medicare Part A
•	Not receiving Medicaid benefits	Payment of
Part B premium	
Applicants for the above programs must be Arizona residents and either U.S. citizens or qualified immigrants. Applicants may need to provide documentation of U.S. Citizenship or immigrant status.
Applicants for the Children, Caretaker Relative, Pregnant Women, Adult, and SSI-MAO, who do not meet the citizen/immigrant status requirements may qualify for Emergency Services.
NOTES:	1. Income deductions vary by program but may include work expenses and educational expenses.
2. AHCCCS Medical Services include, but are not limited to, doctor’s office visits, immunizations, hospital care, lab, x-rays, and prescriptions.
3. If the applicant has a spouse living in the community, between $30,828 and $154,1400 of the couple’s resources may be disregarded.
4. *Each additional” approximate amounts only.