1. 1. Right to apply. A person may apply for AHCCCS medical coverage by submitting an Administration-approved application to the Administration or its designee, an FAA office, or one of the following outstation locations:

   1. a. A Federally Qualified Health Center or disproportionate share hospital under 42 U.S.C. 1396r-4; or
   2. b. Any other site, including a hospital, approved by the Administration or its designee.

2. 2. Application. To initiate the application process, the Administration or its designee will accept an application from the applicant, an adult who is in the applicant’s household, as defined in 42 CFR 435.603(f), or family, as defined in section 36B(d)(1) of the Internal Revenue Service (IRS) Code, an authorized representative, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant by submitting a written or online application under 42 CFR 435.907.

   1. a. A phone or written application must contain at least the following to be submitted to the Administration or its designee:

      1. i. Applicant’s legible name,
      2. ii. Address or location where the applicant can be reached,
      3. iii. Signature of the person submitting the application,
      4. iv. Date the application was signed.
      5. v. The Administration or its designee shall require that a third party witness the signing and attest by signing the application if the individual signing the application signs with a mark.
   2. b. An online application must be completed in full in order to be submitted to the Administration or its designee.

3. 3. Incomplete application. If the application is incomplete, the Administration or its designee shall do at least one of the following:

   1. a. Contact an applicant or an applicant’s representative by telephone or electronic medium to obtain the missing information required for an eligibility determination;
   2. b. Mail a request for additional information to an applicant or an applicant’s representative, allowing 10 days from the date of the request to provide the required additional information; or
   3. c. Meet with the applicant, representative, or household member.
4. 4. Date of application. The date of application is the date application is received by the Administration or its designee either on-line or at a location listed in subsection (1).
5. 5. Complete application form. The Administration or its designee shall consider an application complete when all questions are answered. The same person as listed under subsection (2) is the person that must sign the completed application. The application shall be witnessed and signed by a third party if the individual signing the application signs with a mark.
6. 6. Assistance with application. The Administration or its designee shall allow a person of the applicant’s choice to accompany, assist, and represent the applicant in the application process.

Application process.

Historical Note

Adopted effective August 30, 1982 (Supp. 82-4). Former Section R9-22-302 repealed, new Section R9-22-302 adopted effective November 20, 1984 (Supp. 84-6). Amended effective January 1, 1987, filed December 31, 1986 (Supp. 86-6). Amended effective September 29, 1992 (Supp. 92-3). Amended under an exemption from the provisions of the Administrative Procedure Act, effective July 1, 1993 (Supp. 93-3). Section repealed by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section reserved by final rulemaking at 19 A.A.R. 3309, effective November 30, 2013 (Supp. 13-4). New Section made by final rulemaking at 20 A.A.R. 192, with an immediate effective date of January 7, 2014; the adoption of this Section was slated to be codified in Supp. 14-1 but due to a clerical error, was not published. The new Section was published in Supp. 20-4 and no additional amendments have been made to this Section since January 7, 2014 (Supp. 20-4). Amended by final rulemaking at 31 A.A.R. 1834 (June 6, 2025), effective July 14, 2025 (Supp. 25-2).