Arizona Long Term Care System (ALTCS) Benefits and Eligibility in 2023
What is the Arizona Long Term Care System?
ALTCS (usually pronounced as "alt-cs") stands for Arizona Long-Term Care System. It is a state-administered Medicaid program that provides long-term care services to eligible Arizona residents who are aged, blind, disabled, or have a developmental disability. The program is designed to help individuals who require ongoing care and support with activities of daily living, such as bathing, dressing, and eating, as well as medical services, prescription drugs, and other necessary support.
ALTCS provides a range of services, including home and community-based services, nursing home care, and assisted living services. Eligibility for the program is based on a combination of financial and medical criteria, including income and assets, medical condition, and functional impairment. To be eligible for ALTCS, individuals must meet both the medical and financial eligibility criteria.
Once enrolled in the program, individuals receive a care plan that is designed to meet their specific needs and preferences. The care plan may include services such as personal care, skilled nursing care, therapy services, medical equipment and supplies, transportation, and other support services. The goal of ALTCS is to provide individuals with the care and support they need to live as independently as possible in their own homes or in a care facility, while also helping to control the costs of long-term care.
Who is Eligible for ALTCS Benefits in 2023?
To be eligible for ALTCS (Arizona Long-Term Care System), an individual must meet both the medical and financial eligibility criteria. The specific eligibility requirements are as follows:
Medical Eligibility (2023):
The individual must be an Arizona resident.
The individual must be aged 65 or older, blind, or disabled, as defined by the Social Security Administration.
The individual must meet the functional eligibility criteria, which means that they need assistance with at least two activities of daily living (ADLs), such as bathing, dressing, eating, toileting, transferring, or continence.
Alternatively, the individual may have a medical condition that requires nursing home level of care.
Financial Eligibility (2023):
The individual must meet the income and asset requirements, which are set by the state of Arizona.
For single individuals, the monthly income limit is $2,742, and the asset limit is $2,000.
For married couples, the monthly income limit is $5,484, and the asset limit is $4,000.
Certain assets, such as a primary residence, personal belongings, and a vehicle, are exempt from the asset limit.
What happens if I do not meet the medical eligibility requirements for ALTCS?
If you do not meet the medical eligibility requirements, it means that your medical condition may not meet the level of need required by ALTCS. In this case, you may consider these other options for care and support:
Reapply: If your health gets worse, you can apply again. Make sure to give new medical papers to show your health changes.
Appeal the decision: If you think the decision is wrong, you can fight it. Follow the steps in the letter that said you don't qualify, and ask a lawyer or legal group for help if you need it.
Look at other Medicaid programs: Arizona has other programs that might help you. Check the Arizona Health Care Cost Containment System (AHCCCS) website for more info.
Find other help: There are other government programs that might help you with healthcare and other needs. Look into Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Area Agency on Aging to see if they can help you.
Private insurance or self-pay: If you are unable to receive assistance from the government, it may be worth considering private insurance or covering the cost of care yourself. Please keep in mind that long-term care can be quite expensive, so it's important to take the time to plan thoughtfully.
Talk to a professional: It may be helpful to speak with a professional about your situation. Consider reaching out to a social worker, case manager, or healthcare worker for guidance on what steps to take.
What if I'm over the ALTCS monthly income limit?
If you are over the income limit, you may still be able to qualify for the program by using certain strategies to reduce your countable income. Here are a few options to consider:
Spend down your excess income: If your income is slightly over the limit, you may be able to spend down your excess income on allowable expenses, such as medical bills or home modifications, to reduce your countable income to the eligibility level.
Use a Qualified Income Trust (QIT): A QIT, also known as a Miller Trust, is a type of irrevocable trust that allows you to redirect your income into the trust and reduce your countable income to the eligibility level. However, there are specific rules and requirements that must be followed when setting up and using a QIT.
Use a Spousal Impoverishment Protection Rule: If you are married and your spouse is not applying for ALTCS, you may be able to use the spousal impoverishment protection rules to reduce your countable income. This rule allows the community spouse to keep a certain amount of income and resources while the other spouse qualifies for ALTCS.
What if the value of my assets are higher than the ALTCS asset limit?
If your assets exceed the ALTCS limit, you have several potential options:
Spend down your assets: You may spend down your assets on care-related or other expenses until you reach the asset limit. This could include paying for medical expenses, home modifications, or paying off debts.
Asset transfers: You may consider transferring assets to a spouse or other family members. However, be cautious as there are specific rules about asset transfers, and improper transfers could lead to a period of Medicaid ineligibility.
Establish a Miller Trust (Income-Only Trust): If your income is too high for ALTCS eligibility, you may consider setting up a Miller Trust. This type of trust allows you to direct your excess income into the trust, which can then be used to pay for your long-term care expenses.
Consult an elder law attorney: Navigating the ALTCS application process and asset requirements can be complicated. An experienced elder law attorney can help you understand your options and develop a plan to preserve your assets while still qualifying for ALTCS benefits.
What services are covered by the Arizona Long Term Care System?
Case management: A case manager helps coordinate and manage an individual's care, including organizing and monitoring services provided by different care providers
Personal care services: Assistance with daily activities such as bathing, dressing, grooming, eating, and toileting.
Homemaker services: Support for tasks like cleaning, laundry, meal preparation, and grocery shopping.
Respite care: Temporary relief for caregivers, allowing them to take a break from their caregiving duties.
Attendant care: Provides supervision and assistance to individuals who need help with daily activities and require constant supervision to ensure their safety.
Home health aide: Assistance from a certified aide who helps with personal care and light housekeeping tasks.
Home health nursing: Skilled nursing services provided in the home, including administering medications, wound care, and monitoring health conditions.
Adult day health care: A structured, comprehensive program offering daytime services such as personal care, health monitoring, therapy, and social activities.
Habilitation services: Training and support to help individuals with developmental disabilities gain, maintain, and improve skills needed for daily living and community integration.
Therapy services: Physical, occupational, and speech therapy services to maintain or improve functional abilities.
Skilled nursing facility care: Short-term or long-term nursing care provided in a licensed facility.
Intermediate care facility services: Care provided in a facility for individuals with developmental disabilities.
Hospice care: Supportive services for individuals with a terminal illness, focusing on comfort and pain management.
Respite care in a facility: Temporary relief for caregivers, allowing them to take a break from their caregiving duties while the individual stays in a licensed facility.
Home-delivered meals: Nutritious meals delivered to individuals who are unable to prepare their own meals.
Home modifications: Modifications to an individual's home, such as installing grab bars or ramps, to improve safety and accessibility.
Medical equipment and supplies: Items like wheelchairs, walkers, and incontinence supplies needed for daily living.
Transportation: Non-emergency medical transportation to and from medical appointments and services.
What other options are available for financial aid besides ALTCS?
Several alternatives to the Arizona Long Term Care System (ALTCS) are available for financial aid, depending on your specific situation, eligibility, and location. One option is Medicare, a federal health insurance program for seniors and some people with disabilities, does not typically cover long-term care but may cover related expenses like short-term skilled nursing care, home health care, and hospice care.
Veterans Affairs (VA) benefits can provide financial assistance for veterans and surviving spouses, with programs like the Aid and Attendance Benefit, Housebound allowance, and VA pension helping to cover long-term care costs. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) offer financial assistance for individuals with disabilities, and although they don't specifically cover long-term care expenses, they can supplement income to help pay for care.
Private long-term care insurance policies can be purchased to cover the cost of care when needed, though they can be expensive. State and local programs may also offer assistance, including home and community-based services, financial aid programs, or low-cost long-term care facilities. Some life insurance policies offer accelerated death benefits or living benefits to help with long-term care expenses, while reverse mortgages can provide funds for homeowners aged 62 or older.
Finally, as a last-resort plan, pooling family resources or using personal savings and investments can be another way to fund long-term care. It is important to research all available options and consult with a financial advisor or an elder law attorney to help determine the best financial aid solution for your specific needs.