Please rate Application Altcs 09-2026
To start the application process, you can call 888-621-6880 (toll-free) or register an application online at Health-e-Arizona Plus.
Interview: an interview is required to complete the ALTCS application process.
Financial interview: the customer is not required to attend if the legal guardian/conservator or authorized representative completes the interview for the customer.
SSN: you must provide or apply for a Social Security number for every applicant; immigrants who are not legally able to obtain one are not required to provide one.
Return: a completed Request for Application may also be returned online at Health-e-Arizona Plus, by fax (toll-free) or by e-mail.
Authorization: pages 5 to 7 hold the Authorization To Disclose Protected Health Information To AHCCCS.
| Question | Answer |
|---|---|
| Form Name | DE-101/DE-202 |
| Form Length | 7 pages |
| Fillable? | Yes |
| Fillable fields | 120 |
| Avg. time to fill out | 20 min |
| Edition | rev 09/2026 |
| Where to send | Fax (toll-free) 888-507-3313; e-mail altcsregistration@azahcccs.gov; mail AHCCCS P.O. Box 6050 MD 15023 ALTCS Phoenix AZ 85002-5520 |
| Other names | DE-101, DE-202, DE101, DE202, ALTCS application, Arizona ALTCS application, Request For Application For Arizona Long Term Care System |
| Official source | DE-101/DE-202 (Rev 09/2026), Arizona Health Care Cost Containment System |
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