ALTCS – Arizona Long Term Care System
Are you or an elderly or disabled loved one in need of additional care, but worried about the expense that comes with long-term assistance? You may qualify for the Arizona Long Term Care System (ALTCS), which provides senior citizens and disabled individuals with monetary assistance to pay for continued care. While qualifying can be a lengthy and complicated process, the Dyer, Bregman & Ferris Public Benefits practice assists families planning, qualifying, and applying for ALTCS benefits.
Not only are we by your side during the application process, but we also look for lesser-known potential benefits available, including VA aid and attendance benefits, and other VA or public benefits. We know how expensive care can be and are committed to maximizing your benefits so you and your loved ones can look forward to the future with peace of mind.
What Is ALTCS?
The Arizona Long Term Care System is an Arizona Medicaid program overseen by a state organization called the Arizona Health Care Cost Containment System (AHCCCS). The ALTCS program is designed to assist those in need of either full nursing home care or home and community- based services that assist people who would otherwise require full nursing home care. The ALTCS program operates under a federal waiver, which means that the state does not follow the rules required in other states.
Arizona’s rules are constantly changing and evolving to meet its residents’ needs, so it’s crucial to contact a lawyer to stay up-to-date with the latest requirements. The compassionate attorneys at Dyer, Bregman & Ferris will ensure you’re aware of the latest developments and can obtain the most benefits available.
Benefits of Planning
Don’t underestimate the value of planning ahead! Exploring your options in advance can be a huge benefit to you for a number of reasons. Some of these include:
- Providing a smooth transition from private pay to public benefits.
- Minimizing the out of pocket expenses to the applicant and his/her spouse.
- Sheltering and protecting the assets within the framework that the state allows.
- Reviewing all the options and choosing those with the least risk and greatest benefit.
- Avoiding or minimizing the state’s ability to perform estate recovery
As with all public benefits, an applicant must meet certain criteria to qualify for the program. These requirements include proving that you:
Are U.S. Citizen or Qualified Alien
Have a Social Security Number
Are an Arizona Resident
There are four additional components to ALTCS eligibility, which we’ll explore in more detail below:
An appropriate living arrangement is either the applicant’s home or apartment, or if they are living in or with a family member in their home or apartment. If the applicant is living in a Group Home, Assisted Living Community, Skilled Nursing facility, or Memory Care Unit, the facility must participate with ALTCS and have contracts in place with at least one of the Program Contractors to be considered an appropriate living arrangement.
In order to qualify for the ALTCS program, a person has to require a level of care that places him or her “at risk” of nursing home care. This determination is done through a survey tool known as the Pre-Admission Screening (P.A.S.). This tool assesses the applicant’s ability to perform his/her activities of daily living.
Daily activities taken into consideration include mobility, transfer, toileting, dressing, feeding, bathing, grooming, and meal preparation. All of these components are then quantified, and an applicant must score 60 points or higher to be considered medically eligible for this program.
The state looks at income and resources differently, depending on whether the person is married or single.
Single Person Income – The single individual monthly income limit is $2,250. If a person’s monthly income is over $2,250 but below the average cost of care for the county in which he/she resides (as determined by AHCCCS, i.e. $7,134.44 for Maricopa County), the applicant could still potentially qualify with a Miller’s/Income Only Trust.
Single Person Resources – The resource limit for a single individual is $2,000 in “countable” assets. In order to qualify for ALTCS benefits, an individual must have less than $2,000 of liquid assets in cash, property, life insurance policies, or other assets.
Married Couples are treated differently because the state does not want to impoverish the healthy spouse. The eligibility for married persons is as follows:
Married Couples Income – The income limit for a married couple is determined in several ways.
- If the applicant’s gross monthly income is less than $2,250, the applicant qualifies regardless of the spouse’s income.
- If the applicant’s gross monthly income is greater than $2,250, but the combined income of the applicant and the spouse is less than $4,500, then the applicant can qualify.
- If the applicant’s income is greater than $2,250 and the couple’s combined gross monthly income is greater than $4,500, then a Miller’s/Income Only Trust can be used in some cases to qualify, which solves the problem of too much income when a person is applying for ALTCS.
- An Income Only Trust raises the applicant’s income limit to $7,134.44 (for Maricopa County) and the couple limit to $14,268.88.
- If the applicant’s income is greater than $7,134.44 and the couple’s combined gross monthly income exceeds $14,268.88, the applicant will not qualify.
Married Couples Resources – A Resource Assessment is required only in the case of a married person. The Resource Assessment is the process by which the state determines how much the Community Spouse is entitled to have in countable resources and still allow the applicant to qualify for benefits. The Resource Assessment looks at the first period of continuous institutionalization or when the individual first began receiving home health services that prevented institutionalization for at least 30 consecutive days. Through the Resource Assessment, the state will total the combined countable marital assets as of the first period of continuous institutionalization. The minimum that all Community Spouses are entitled to is $24,720. Otherwise, the total countable assets are divided in two with a maximum allowance for the community spouse of up to $123,600.
For example, if the total combined assets are determined to be $150,000, then the spousal resource limit would be $75,000 – half the countable assets. Conversely, if the total combined assets are determined to be $300,000, then the spousal resource limit would be set at the maximum of $120,900, not $150,000. Additionally, the applicant is entitled to have up to $2,000 in his/her name at the time of application.
All components of eligibility must be met before the state will grant approval; a person cannot apply before they are eligible and obtain approval. Note: Different limits apply if both spouses are seeking benefits.
Share of Cost
A Share of Cost is the amount of money, if any, that the applicant pays for their care to the program contractor of the facility for the services they receive under the ALTCS program.
How is Share of Cost Calculated?
Estate Recovery is the State’s ability to take assets after the death of the applicant to recoup costs of care provided by the ALTCS program.
Conditions for Recovery
- Must be over the age of 55 when services were received.
- No surviving spouse, minor child, or disabled child (of any age).
Don’t Hesitate – Determine Your ALTCS Eligibility Today!
Don’t spend another day worrying about your future or that of a loved one. If you or a family member needs long-term care and the expense is daunting, contact an attorney at Dryer, Bregman & Ferris immediately to schedule your ALTCS consultation. We’ll help you understand your potential eligibility and find ways to maximize additional benefits. The earlier the process is started, the better…and we’ll be by your side every step of the way.