Mercy Care Plan in Arizona: Eligibility and How to Apply

Eligibility for the Mercy Care plan in Arizona runs through AHCCCS, the state’s Medicaid program. If you meet AHCCCS’s rules on Arizona residency, citizenship or qualified immigration status, and household income, you can then choose Mercy Care as the health plan that coordinates your care. Most non-disabled adults qualify when household income is at or below 133% of the federal poverty level, but children, seniors, people with disabilities, and long-term care applicants have their own income pathways.

Why AHCCCS Decides, Not Mercy Care

AHCCCS is Arizona’s Medicaid agency. It sets the eligibility rules, reviews applications, and funds the coverage.¹ Mercy Care is one of several managed care organizations AHCCCS contracts with to build provider networks and deliver services to enrolled members.

You do not apply to Mercy Care. You apply to AHCCCS. Once AHCCCS approves you, you select Mercy Care (or another plan available in your area) as the organization you’ll deal with for doctors, prescriptions, and hospital care. So the eligibility question is really an AHCCCS eligibility question.

Residency and Citizenship

You must be an Arizona resident. You also need to be a U.S. citizen or hold a qualified immigration status to receive full AHCCCS medical coverage.² Noncitizens who don’t meet the qualified status test can still receive coverage for federal emergency medical services, but they won’t qualify for full benefits or for programs like KidsCare or the Arizona Long Term Care System.³

Income Limits by Category

AHCCCS measures income against the federal poverty level (FPL), but the threshold depends on which program you’re applying under. For 2026, the FPL is $15,960 per year for a single person and $33,000 for a family of four.⁴ The main categories and their 2026 income limits are below.

Adults Ages 19 to 64

For adults who aren’t on Medicare and don’t have a disability determination, income must be at or below 133% of the FPL.⁵ The monthly ceiling depends on household size:

1 person: $1,769
2 people: $2,399
3 people: $3,028
4 people: $3,658

Adult eligibility also requires that any children in the household have health insurance, and you can’t be eligible for another Medicaid category.²

Children and KidsCare

Children under 19 with household income at or below 225% of the FPL qualify for KidsCare. A family of four can earn up to $6,188 per month. Families pay a monthly premium of $10 to $70 that covers all eligible children in the household. Children whose family income falls low enough to meet the regular AHCCCS Medicaid thresholds are enrolled in that program instead, and there’s no premium.²

Aged, Blind, or Disabled

People age 65 or older and those determined to be blind or disabled may qualify through SSI-related categories. The SSI cash program uses 100% of the federal benefit rate, which is $994 per month for an individual and $1,491 for a couple, and applies asset limits of $2,000 for an individual or $3,000 for a couple. The SSI Medical Assistance Only (MAO) program uses 100% of the FPL ($1,330 individual, $1,804 couple) and has no asset test.²

Long-Term Care (ALTCS)

If you need nursing-home-level care, the Arizona Long Term Care System covers both facility care and home-and-community-based services. Income can go up to 300% of the federal benefit rate, or $2,982 per month for an individual, but there’s a $2,000 asset limit and you may have to pay a share of the cost.²

These are the most common categories. Pregnant women, caretaker relatives, and certain other groups have their own income pathways, all listed in the full AHCCCS eligibility chart.

How to Apply

Apply to AHCCCS first; Mercy Care enrollment follows approval. There are three ways to submit an application:⁶

Online through the Health-e-Arizona Plus (HEAplus) portal at healthearizonaplus.gov. This is the fastest route and lets you apply for medical coverage, nutrition assistance, and cash assistance on one application.⁷
In person at a Department of Economic Security (DES) Family Assistance Office. Community partners can also help you complete the online application.
By mail, using a paper application downloaded from the DES website.

You’ll need to provide proof of identity, Arizona residency, citizenship or qualified immigration status, and every source of household income. One application covers everyone in your household.

Processing Times

AHCCCS processing deadlines vary by situation:⁸

Most programs: 45 calendar days from the application date
Disability-based programs (SSI-MAO or Freedom to Work): 90 calendar days
Pregnant applicants: 20 calendar days
Hospitalized applicants: 7 calendar days if no additional documentation is needed; otherwise 45 days

Retroactive Coverage

For most newly eligible members, coverage is retroactive only to the first day of the month AHCCCS received the application. It does not reach back further. Pregnant women and children under 19 are the exception: if they would have qualified during any of the three months before the application month, AHCCCS covers that earlier period as well.⁹ If you’re an adult with unpaid medical bills from before you applied, those bills generally won’t be covered.

Choosing Mercy Care After You’re Approved

Once AHCCCS approves your application, you pick a managed care organization. Mercy Care is one of several options, depending on where you live. If you don’t choose within the required window, AHCCCS assigns you to a plan.

You can change plans during the first 90 days of AHCCCS enrollment through HEAplus, by calling HEAplus at 1-855-432-7587, or by contacting AHCCCS at (602) 417-7100. After that initial period, you can request a change at your annual re-enrollment, if your family members are in different plans and you want everyone on the same one, or if you move to an area where your current plan doesn’t operate.¹⁰

Mercy Care operates several distinct lines within AHCCCS, including general Medicaid, long-term care, developmental disabilities, serious mental illness, and DCS CHP for children in foster care.¹¹ The line you’re placed on depends on which AHCCCS program you qualify under.

Keeping Your Coverage

Reporting Changes

You must report changes that could affect eligibility within 30 days. That includes changes in income, household size, address, pregnancy, or other insurance. You can report through HEAplus, by phone, or at a DES office. Failing to report can result in receiving benefits you don’t qualify for, which creates problems at renewal.

Annual Renewal

AHCCCS reviews eligibility every 12 months. In many cases the state can renew you automatically by checking electronic data sources, and you’ll simply get a letter listing the information used.¹² When the state can’t verify eligibility electronically, you’ll receive a prepopulated renewal form. You need to review it, correct anything wrong, provide any requested documents, sign it, and return it within 30 days. Renewals can be completed online through HEAplus, by mail, fax, phone, or in person.

Missing the renewal deadline is one of the most common ways people lose AHCCCS coverage, and it usually traces back to a renewal letter that went to an old address. If your coverage is terminated for a missed renewal, you can submit the completed form within 90 days of the cutoff without filing a new application, but you won’t have coverage during that gap. Keep your mailing address current.

Starting with renewals scheduled on or after January 1, 2027, federal law will require adults in the Medicaid expansion group to renew every six months instead of every 12.¹³ That change will apply to most non-disabled adults on AHCCCS.

1
Arizona Health Care Cost Containment System (AHCCCS). Medicare Advantage Organization Agreement Between AHCCCS and Mercy Care
2
AHCCCS. AHCCCS Eligibility Requirements February 1, 2026
3
AHCCCS. Non-Citizen Status Overview
4
U.S. Department of Health and Human Services. 2026 Poverty Guidelines for the 48 Contiguous States
5
AHCCCS. Income Standards – Section 615
6
AHCCCS. Apply for AHCCCS Medical Assistance/KidsCare
7
Arizona Department of Economic Security. Health-e-Arizona Plus Application for Benefits
8
AHCCCS. Eligibility Information
9
AHCCCS. Retroactive Coverage (Prior Quarter Coverage)
10
AHCCCS. Choosing a Health Plan
11
Mercy Care. Contact Us
12
AHCCCS. Renewal Processes
13
Centers for Medicare and Medicaid Services. Implementation of Eligibility Redeterminations under Section 71107 of the WFTC Legislation