Arizona calls its Medicaid program the Arizona Health Care Cost Containment System (AHCCCS). However, the Medicaid office that serves elderly and disabled individuals with long term care needs is the Arizona Long Term Care System (ALTCS). The program that serves this population is sometimes referred to as the Elderly & Physical Disability (E/PD) Program.
Instead of the Medicaid waiver system, which has participant enrollment caps, Arizona operates ALTCS differently than most states. Elderly and disabled residents are provided care, including nursing home care and home and community based services (HCBS), on a managed care model. Via this model, services and benefits are an entitlement, which means that anyone who meets the eligibility requirements are able to receive services. When a Medicaid candidate is accepted into ALTCS, he or she meets with a caseworker to determine a health care plan that covers long-term care needs, including care in a variety of settings (i.e., home, nursing homes, adult foster care, and assisted living).
It should be noted that with alternative residential care, sometimes called assisted living or senior living, the room and board portion of the monthly fees are not considered medical services. Therefore, it is not paid for by ALTCS.
For the consumer, there are both positives and negatives to this managed care delivery model. The system simplifies logistics for the care recipient, as they work entirely with a single organization, and very likely, a single individual for coordination of all care requirements. On the downside, the managed care model decreases flexibility and consumer choice. Critics have voiced concerns regarding access to geographically convenient, high quality services.
Several years ago, ALTCS began a new sub-program option called “Agency with Choice“. Under this option, ALTCS beneficiaries, who live in their homes and receive care, are allowed to share the hiring, training, and dismissal responsibilities of their caregivers with the state. A second option for self-direction for ALTCS program participants exists and is called Self-Directed Attendant Care.
In order to be eligible for ALTCS, an individual must be a resident of Arizona who is over the age of 65 or have a recognized disability, such as being blind. The ALTCS staff considers both the resident’s level of physical or mental impairment and their available income and financial assets.
Applicants must need a level of care typically provided in a skilled nursing home or an intermediate care facility. To clarify, it is not necessary that they currently be receiving that level of care, only that they are assessed by Arizona Medicaid (AHCCCS) and found to need it.
Monthly Income Limits
Arizona residents can have no more than 300% of the SSI Federal Benefit Rate (FBR) in monthly income. This means that single applicants (as of 2021) should not have more than $2,382 in gross monthly pay. Married applicants, with both spouses applying for services, must have monthly income no greater than $4,764. (Each spouse can have up to $2,382 / month in income.)
Arizona follows a special set of rules to protect the financial security of a healthy spouse, also called the community spouse, well spouse, or non-applicant spouse, when his or her spouse needs long-term care. This means that the state will permit an applicant spouse to transfer income to a non-applicant spouse. This is commonly called a monthly maintenance needs allowance, but in Arizona, it is called a community spouse monthly income allowance (CSMIA). This spousal allowance protects the non-applicant spouse from having too little income from which to live. As of 2021, an applicant spouse may transfer up to $3,259.50 / month in income to his/her non-applicant spouse in order to bring his/her monthly income to this level.
It is still possible to qualify for ALTCS with income over the limit should the excess income be allocated to an income only trust, also called a Miller Trust. In Arizona, this type of trust is often called a Special Treatment Trust (STT). To learn more about Medicaid qualifying income trusts, one should contact a planning professional familiar with Arizona Medicaid.
Arizona has defined both ‘countable assets’ and ‘exempt assets.’ Countable assets are defined as checking and savings accounts, homes other than the primary home in which the applicant resides, certificates of deposit, and stocks and bonds. Exempt assets include a home (given the applicant’s equity interest is not over $603,000 and the applicant lives in it OR a non-applicant spouse lives in it), a primary vehicle, burial plots, and up to $2,000 in cash reserves. If an applicant is married and his or her spouse is also applying for Medicaid, up to $4,000 in cash reserves is allowed. (Each spouse can have up to $2,000 in assets). However, the asset limits only apply to countable assets.
As mentioned above, Arizona follows a special set of rules to protect the financial security of a non-applicant spouse, when his/her spouse requires long-term care. This means that the state will permit a much higher level of resources to be held by the non-applicant when only one spouse is applying for Medicaid. As of January 2021, this amount may be as much as $130,380. In most states, this is called the Community Spouse Resource Allowance (CSRA), but in Arizona it is called the Community Spouse Resource Deduction (CSRD). Please note that the applicant spouse is still able to keep up to $2,000 in assets.
Should one have more assets than the allowable limit, it is possible to convert countable assets into exempt ones, such as using funds to modify one’s home to be wheelchair accessible. By doing so, a person can lower their countable assets, and hence, meet Medicaid’s asset limit. This option is most likely to help those who are close to the limits and still cannot afford their cost of care. To consider how to restructure your financial assets, one should consult with a Medicaid planner. Simple errors can delay benefits and may disqualify an applicant from Medicaid.
It is important to note: Medicaid has a look-back period immediately preceding the date of one’s Medicaid application. In Arizona, this is a period of 60-months in which all past assets are reviewed to ensure nothing was sold for less than it was worth or given away in order to meet Medicaid’s asset limit. If one is found to have violated this rule, a period of Medicaid ineligibility will ensue.
The benefits of ALTCS depend on the care environment where one resides. Nursing home residents, for example, receive a different level of support than those residing in assisted living or at home. Besides medical care, an ALTCS participant may receive the following care and assistive services:
The Arizona Long Term Care System is available in all counties of the state. To start an application, call your local ALTCS office. Persons can also contact ALTCS at 1-888-621-6880. It is first determined if an applicant meets the financial criteria, and if so, the process continues with a social worker conducting an in-person assessment of the applicant to determine the level of care need. To learn more about ALTCS, click here.