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Arizona Medicaid’s Self Directed Attendant Care (SDAC) Program

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Waiver Description

Arizona’s Self Directed Attendant Care (SDAC) program is less of a program and more of an option for directing care services for those receiving 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, and manage, and even fire, their own personal care provider, who is sometimes also called an Attendant Care Worker (ACW). Program framers intended to allow elderly and disabled Arizona residents to remain living at home instead of residing in nursing facilities or assisted living 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. The program pays the total costs associated with an eligible individual’s personal care. The Fiscal Employer Agent handles payments to providers and for approved supplies on behalf of the participants.

Family members, including spouses and adult children, can be hired as Attendant Care Workers.

One component of SDAC that makes it attractive to its participants is that family members and friends can be hired as the Attendant Care Worker. Family members who have had to quit their jobs or reduce their hours to care for an elderly loved one will be glad to learn that they may be paid for their work 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. One detail to note is that the personal care provider or attendant care worker must be trained in first aid and CPR.

Naming Confusion - SDAC is a Medicaid program option, and in Arizona, Medicaid is referred to as the Arizona Healthcare Cost Containment System (AHCCCS). Within that organization, there is the Arizona Long Term Care System (ALTCS) for elderly and disabled residents. The SDAC Program is one option within ALTCS. Furthering the confusion is the fact that this type of program in which the participant directs their own care is also referred to by many names including; Consumer Direction, Participant Direction and Cash and Counseling. In addition, Arizona has another Medicaid program option under ALTCS that allows for participant direction: Agency with Choice.

Eligibility Guidelines

Elderly and disabled Arizona residents that 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 or Arizona Health Care Cost Containment System (AHCCCS) considers an applicant's income and assets. Asset transfers in the past five years are also considered to prevent individuals from simply shifting their assets to family members to qualify. This “look back” period is called the Medicaid Look Back Period, and if found in violation, one may not qualify for Medicaid for a period of time.

For 2019, the individual income limit is $2,313 / month, or said another way, $27,756 / year, and the resource limit is $2,000. For applicants who are married with both spouses applying for Medicaid, the income limit is double at $4,626 / month or $55,512 / year. The resource limit is also higher at $4,000. However, it’s important to note, some assets, such as the home the individual, or their spouse, lives in is exempt, given it is valued under $585,000. Other exemptions include a single vehicle, personal belongings, household items, and burial plots.

Income Calculations – In 2019, Arizona Medicaid maintains $2,313 as the gross monthly income limit for program participants. Many families considering the program want to determine if their loved one meets the income limit. All annual income should be added up and divided by 12 to find if one might meet the monthly income limit. Also, applicants who receive retirement benefits from Social Security Administration or a pension plan will need to remember that the health insurance premiums are taken out of their income before it is deposited in their bank. In order to calculate the gross monthly income level, these premiums should be added to the net amount deposited each month. Even applicants who are just a dollar over the income limit will not be approved.

Persons whose income and / or assets are more than these limits might still qualify for Medicaid. For instance, one over the income limit might establish a Miller Trust, and one over the asset limit might “spend down” assets on one’s that are considered exempt by Medicaid. Those who find themselves over the limit(s) should consider contacting a Medicaid planning expert to determine if they can qualify.

Benefits and Services

This program pays for personal care services or services that help an individual perform their activities of daily living. This includes such things as assistance with bathing, personal hygiene, putting on / taking off clothing, using the bathroom, and mobility. Assistance may also be received with basic housework, meal preparation, and shopping for essentials. The Attendant 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. 

Did You Know?  By 2020, 25% of Arizonans will be over the age of 60.  This represents a 50% increase since the turn of the century.

How to Apply / Learn More

To enroll in the SDAC Program, an individual must first be approved for Arizona’s Long Term Care System. One applies at any of the ALTCS office locations. More information about this program is available in this downloadable brochure and in the 89-page program manual. Self-Directed Attendant Care is available statewide.

As mentioned previously, another option AZ residents should investigate is the Agency With Choice program. This similar program also allows for consumer direction of services and has no waiting lists for services.