Arizona’s Self Directed Attendant Care (SDAC) program is less of a program and more of an option for directing care services via Arizona’s Long Term Care System (ALTCS). This option is based on the Cash and Counseling model and allows participants flexibility to decide which services best meet their needs. It also allows participants to hire, train, manage, and even fire their own personal care provider, who is sometimes called a direct care worker (DCW) or attendant care worker (ACW). Unfortunately, this option is not available for elderly and disabled Arizona residents who reside in assisted living facilities or nursing home residences.
Program participants work with a case manager to develop a plan of care that outlines the service(s) and meets the needs of the individual. SDAC pays the total costs associated with an eligible individual’s personal care. The Fiscal Employer Agent handles provider and supplier payments on behalf of the participants.
Family members, including spouses and adult children, can be hired as direct care workers.
One component of SDAC that makes it particularly attractive to its participants is the ability to hire family members and friends as the direct care worker. Family members who have had to quit their jobs or reduce their hours to care of an elderly loved one will be glad to learn that they may be paid as caregivers. However, there are some restrictions. Legal guardians cannot be hired as caregivers, and spouses can be retained indirectly only by working with a home care agency. Furthermore, the personal care provider or attendant care worker must be trained in first aid and CPR.
Elderly and disabled Arizona residents who are qualified for Medicaid via Arizona’s Long Term Care System can benefit from this program. Individuals must require a nursing home level of care and be willing and able to receive that care at home.
Arizona Medicaid, also called the Arizona Health Care Cost Containment System (AHCCCS), considers an applicant’s income and assets. Asset transfers in the past five years immediately preceding application are also considered to prevent individuals from simply shifting their assets to family members to qualify. This is called the Medicaid Look Back Period, and if found in violation, one may be penalized with a period of ineligibility.
For 2023, the individual income limit is $2,742 / month, and the asset limit is $2,000. For applicants who are married with both spouses applying for Medicaid, the income limit is double at $5,484 / month. The asset limit is also higher at $4,000. However, some assets, such as the home the applicant lives in is exempt, given his/her equity interest is valued under $688,000. Other exemptions include a single vehicle, personal belongings, household items, and burial plots.
Persons whose income and / or assets are greater than these limits might still qualify for Medicaid. For instance, one over the income limit might establish a Miller Trust, while one over the asset limit might “spend down” assets. Those who find themselves over the limit(s) should consider contacting a Medicaid planning expert to determine if they can qualify.
This program pays for personal care services / attendant services or services that help an individual perform their activities of daily living, which include assistance with bathing, personal hygiene, putting on / taking off clothing, using the bathroom, and mobility. Assistance may also be provided for activities like basic housework, meal preparation, and shopping for essentials.
The direct care worker can perform basic skilled nursing tasks, such as glucose and insulin monitoring, non-sterile wound care, enemas, etc., provided they have received training from a nursing professional. This program also covers the cost of equipment to promote independence, such as shower chairs, grab bars, and walkers.
To enroll in the SDAC program, an individual must first be approved for Arizona’s Long Term Care System. One can apply at any of the ALTCS office locations. More information about this program is available in this downloadable brochure, in this 87-page program manual, and on the AHCCCS’s website. Self-Directed Attendant Care is available statewide.
Another option Arizona residents should investigate is Agency With Choice. This similar program also allows for consumer direction of services and has no waiting lists for services.