Arizona’s Agency with Choice program (AWC) is an option from Arizona’s Medicaid program, which is called the Arizona Health Care Cost Containment Center System (AHCCCS). AWC is a program option for elderly state residents enrolled in the Arizona Long Term Care System (ALTCS), which is the state’s Medicaid program for seniors and disabled individuals who require long term care. Via AWC, elderly state residents are able to be active participants when it comes to attendant care and other services in their homes.
Under AWC, participants can receive care from family members.
The Agency with Choice program allows for “modified self-directed care.” Instead of elderly participants having to accept the caregiver that they are given, they have the option to choose their own caregivers via a provider agency. Qualified applicants have the freedom to direct their own care without being the legal employer of the personal care aide. Many Arizona families celebrated the right to choose the caregiver due to the fact that the program participant can elect to “hire” a family member (including spouses) to care for them, despite Arizona’s Medicaid agency setting the approved hourly wage.
Agency with Choice is designed for people who live in their own homes and would prefer to receive care in that setting rather than in a nursing home. Applicants must be enrolled in the Arizona Long Term Care System (ALTCS), and must qualify functionally and financially for the program to be eligible.
To be functionally eligible for AWC, a person must require the level of care that a nursing home or intermediate care facility provides, and without these services, the individual would need to reside in one of these facilities. A state caseworker conducts the Personal Care Assessments during the application process. Separately, state staff evaluate whether the applicant shows the level of impairment necessary for long-term care.
As of January 2021, single applicants must have an income no greater than $2,382 per month, an amount equivalent to 300% of the SSI Federal Benefit Rate. Married applicants, with both spouses applying for services, are able to have twice the single income limit, or $4,764 monthly. Special rules allow married applicants to only have their individual income—not their joint income—used for the application criteria. If only one spouse of a married couple is an applicant, a monthly maintenance needs allowance, essentially a spousal income allowance, may be relevant. This income allowance is intended to protect non-applicant spouses with little to no monthly income from becoming impoverished. As of 2021, applicant spouses may transfer up to $3,259.50 / month to their non-applicant spouses in specific situations.
A single applicant can possess assets valued up to $2,000, and married couples, with both spouses applying for Medicaid benefits, can have assets up to $4,000. Unlike income, assets of married couples are considered jointly owned. (Learn more about joint assets and Medicaid.) However, certain assets are considered exempt (non-countable), and include the value of their home, given the applicant’s equity interest under $603,000. (An applicant’s home equity interest is not considered if a non-applicant spouse lives in the home). Other exempt (non-countable) assets include household belongings, personal items, one auto, and funeral contracts. Under certain circumstances, an applicant’s healthy (non-applicant) spouse can retain up to $130,380 in their accounts, which is in addition to the $2,000 in assets the applicant spouse can keep. The assets to which a non-applicant spouse is entitled is called a community spouse resource allowance.
If an applicant under the age of 65 possesses assets or income higher than the limit(s), there may be several helpful options, such as setting up different trusts. There is professional assistance available to help families plan for Medicaid eligibility and guide them on protecting financial resources and property for the non-applicant spouse. Read more.
The primary benefit provided under AWC is Attendant Care and most importantly, the ability to self-direct it. This includes hiring, training, managing, and even firing, the care attendant. Attendant Care is defined as personal assistance with:
The total cost of benefits offered under the Agency with Choice program cannot exceed the amount the same care would have otherwise cost were it provided in a skilled nursing home.
Arizona’s Agency with Choice program option is an entitlement, meaning all eligible applicants are able to choose this option. Therefore, there is no wait list. To enroll in Agency with Choice, one must enroll in Arizona Medicaid Long Term Care Services. This can be done in person at these offices. For additional limited information, click here.
Once financial eligibility is determined, a social worker or nurse conducts an interview to assess whether the individual is medically eligible, i.e. at immediate risk of having to be institutionalized. Once determined eligible, the individual will be assigned to a case manager and can choose their care provider.