Arizona Medicaid Long-Term Care Services (ALTCS)
- Arizona Medicaid Long-Term Care Services (ALTCS) covers long-term care for Arizona residents, helping them afford assisted living and nursing home expenses.
The typical assisted living resident in Arizona pays nearly $47,000 per year for services, and those who live in nursing homes pay even more, with annual rates for shared rooms exceeding $82,000. Fortunately, older adults have state and federal government assistance programs available to them depending on their income, assets and level of need. One in six Medicare beneficiaries in Arizona, including 60% of nursing home residents, rely on the Arizona Medicaid Long-Term Care Services (ALTCS) program. This program is a part of the Arizona Health Care Cost Containment System, the state's Medicaid system.
In most states, Medicaid covers medical expenses and long-term care services via waiver programs. While Medicaid is an entitlement, meaning that everyone who meets qualifications is guaranteed coverage, waivers have limited funding and enrollment caps. An individual may meet the criteria for having their long-term care covered under a waiver program, but if the enrollment cap is reached, they may be placed on a waitlist for services and have to pay for their care out of pocket in the meantime.
In contrast, Arizona’s Medicaid program uses a managed care model. Under this model, long-term care services are an entitlement, and anyone who meets the eligibility requirements can receive coverage. Upon acceptance into the ALTCS program, the individual works with a dedicated caseworker to create a care plan that addresses long-term care needs. This personalized care plan may cover services in a variety of settings depending on the individual’s needs, including their home, an assisted living facility, an adult day care community or a nursing home.
What Does Arizona Medicaid Long-Term Care Services Cover?
The benefits and services ALTCS pays for depends on the individual’s care plan and the environment they live in. For example, the services an assisted living resident obtains under this program differ from services someone who lives in their own home receives.
ALTCS pays for medical services such as preventative and diagnostic care, immunizations, behavioral health care, emergency care and surgery services. Depending on the individual’s care plan, the program may cover long-term care services including:
- Institutional services, including nursing homes and intermediate care facilities
- Home and community-based services
- Speech, occupational and physical therapy
- Community transition service
- Care coordination
- Home health care
- Home modifications
- Homemaker services
- Nonemergency medical transportation
- Private duty nursing care
- Behavioral health services
- Some dental services
- Durable medical equipment and medical supplies
- Attendant care
- Respite care
Within this coverage, there are some limitations. ALTCS doesn’t pay for private rooms in nursing homes unless it’s medically necessary, and home-based services such as housekeeping and meal deliveries aren’t available when the individual is hospitalized. ALTCS covers a max of 600 respite hours per benefit year, and if the individual’s spouse administers attendant care, they’re only paid 40 hours per week for the services they provide.
It’s also important to note that while room and board are covered for nursing home residents, the scope of coverage is limited for assisted living residents. ALTCS pays for many of the services the individual obtains in assisted living, but they typically pay for room and board on their own.
Qualifying for Arizona Medicaid Long-Term Care Services
To qualify for ALTCS, applicants must be at least 65 years old or have a qualifying disability. They must also meet financial and medical eligibility criteria.
An ALTCS applicant can have a monthly income of up to three times the SSI Federal Benefit Rate, which is reevaluated every January. In 2021, the FBR is $794 per month, meaning that Arizona residents can have a monthly pre-tax income of no more than $2,382. If two spouses are applying for ALTCS, the joint income limit is $4,764.
If only one spouse is applying for ALTCS, Arizona has special measures in place to ensure the non-applicant, also called the community spouse, isn’t impoverished. Under the community spouse monthly income allowance rule, the applicant can transfer up to $3,259.50 of their income to the spouse to bring their income up to this level.
Even if an individual is over the income limit, they may still be eligible for services. In Arizona, applicants may allocate excess assets to a special treatment trust. Funds in this trust can be used to pay for the individual’s care. Upon their death, any money still in the trust is reimbursed to Arizona’s Medicaid program.
ALTCS applicants can have up to $2,000 in assets. Not all assets count toward this limit, including one personal vehicle, the individual’s home, their personal belongings, home furnishings and home appliances, burial plots and up to $2,000 in cash reserves. Assets that count toward the max limit include owned vacation or rental properties, additional vehicles, the cash value of some life insurance policies, certificates of deposit, stocks, bonds, and checking, savings and credit union accounts. If both spouses are applying for ALTCS, the asset limit is doubled.
When only one spouse is applying for ALTCS, Arizona has protections in place for the community spouse. The non-applicant can have as much as $130,380 in countable assets under the Community Spouse Resource Reduction rule.
For those who exceed these asset limits, a professional Medicaid planner may help them lower their countable assets to become eligible for ALTCS coverage.
In most cases, applicants must need the level of care that skilled nursing facilities provide to be eligible for ALTCS. Once the individual is determined to be financially eligible, they must have a face-to-face interview with a registered nurse or social worker to determine whether they meet the program’s medical requirements.
Once an individual is approved to ALTCS, the program calculates their cost-sharing responsibilities to determine if or how much they must contribute towards their care costs. This calculation is made based on the individual’s monthly pre-tax income minus:
- A personal needs allowance of $119.10 per month
- A community spouse allowance, if applicable
- A family allowance if dependents are living in the individual’s home
- A home maintenance allowance for those who are in a nursing home temporarily
- Medical insurance premiums
- Medical expenses that ALTCS doesn’t cover, such as vision and hearing services
Applying for Arizona Medicaid Long-Term Care Services (ALTCS)
To begin the enrollment process, individuals may visit their local ALTCS office or call the program’s helpline at (888) 621-6880.