The Arizona Long Term Care System (also known by its acronym ALTCS, pronounced “All-Tecs”) is a health insurance program for qualified individuals aged 65 or older which can help pay for some or all of the costs of long term medical care, which can be provided in a variety of settings including a medical institution, at home, or in a community-based setting. ALTCS exists within the larger Arizona Medicaid program known as the Arizona Health Care Cost Containment System (AHCCCS), and is the office tasked with aiding seniors and disabled Arizona residents with long-term care needs. Unlike some other analogous systems operated by other states, ALTCS is operated on a managed care model, meaning that anyone who meets the program’s eligibility requirement is eligible to receive its services. 

While you should speak with a financial or legal advisor with experience in senior care before making any long term care decisions, for a primer on ALTCS, including information on whether you may be eligible for ALTCS and if so the type of support you could receive, read our blog below or visit the AHCCCS website on ALTCS to learn more.

Who is eligible for ALTCS?

In order to be eligible for ALTCS, an individual must be an Arizona resident age 65 or older and have a recognized disability, such as blindness or significant physical or mental impairment. In addition, in order to be eligible for ALTCS an individual must have made an effort to secure their primary benefits from other sources, such as income from a pension or VA benefits. Finally, an individual must reside at home or in an ALTCS-approved community or facility. 

Outside of these general conditions, there are more specific requirements based on an applicant’s health and financial status. In order to determine whether you meet the health-based eligibility qualifications for ALTCS you will first need to undergo a screening process known as a Pre-Admission Screen (a “PAS” in ALTCS terms) conducted by AHCCCS. The main purpose of this assessment is to determine whether the applicant needs the level of care provided in a skilled nursing home or an intermediate senior care facility. An applicant does not need to currently be receiving this level of care to be eligible, instead their PAS assessor must simply determine that they need this level of care. 

In order to make this determination, the PAS will look at an applicant’s health history and their functional abilities. To determine an applicant’s functional abilities, a PAS will look at the applicant’s ability to perform Activities of Daily Living (known as “ADLs”) which include basic daily activities like feeding, dressing, and bathing. In addition, the assessor will consider any history of medical conditions requiring regular medical treatment or care, such as cognitive impairments like dementia or Alzheimer’s disease. 

In addition to the medical eligibility requirements, an ALTCS applicant must also meet certain financial requirements which focus on two main elements: the applicant’s income and their total assets. In order to qualify for the income requirement, an applicant’s monthly income must not exceed 300% of the SSI Federal Benefit Rate. In 2022, this means that a single applicant cannot make more than $2,523 in gross monthly income in order to be eligible, while married individuals are capped at a combined gross monthly income of $5,046 (with a maximum of $2,523 a month in income for each spouse). 

A unique situation arises where one spouse is healthy and does not require long term care insurance under ALTCS (sometimes called the community spouse, well spouse, or more simply the non-applicant spouse), while the second, applying spouse needs long-term care. In order to make sure that the spouse requiring care will not be barred from getting long-term care because they have too high of an income, ALTCS allows an applicant-spouse to transfer up to $3,435 a month in income to their non-applicant spouse in order to bring their own income under the level required for ALTCS (called a Community Spouse Monthly Income Allowance or CSMIA). 

Even if your income is over the limit established by ALTCS, you may still be able to qualify for ALTCS by allocating income over the limit into an income only trust, sometimes called a Miller Trust or a Special Treatment Trust. In order to learn more about an income only trust and whether one may be able to help you or a loved one, speak to a financial or planning expert who is familiar with ALTCS and Arizona law more generally.

What does ALTCS cover?

The exact services and benefits paid for by ALTCS will depend on each individual’s care plan and where they are living (services can differ depending on whether someone is living in their own home or at an ALTCS-qualified facility). ALTCS is designed to cover medical services, which can include preventative and diagnostic care, surgeries, and emergency care. In addition, your ALTCS program may also cover long-term care services that you might not think of as included in medical services, such as stays in a nursing or intermediate care facility, or a community transition service. In addition, ALTCS may cover a variety of at-home long term care services such as home health care, home modifications, and homemaker or at-home nursing care.

What doesn’t ALTCS cover?

There are some important limitations on ALTCS coverage that are worth keeping in mind. The most important, or at least the most commonly relevant, limitation on ALTCS coverage is that while ALTCS covers room and board for nursing home residents (provided that it’s medically necessary), it generally does not cover room and board for individuals in assisted living. While ALTCS can cover many care services provided in assisted living, an individual will typically pay for their monthly room and board themself. In addition, an individual can only be paid for 40 hours of work per week under ALTCS if they are administering care to their spouse. 

Before making any big financial decisions about paying for senior living, make sure to consult a financial advisor or legal expert who has experience with the ALTCS system. In addition, if you would like to learn more about whether or not you qualify for ALTCS coverage, you can either visit your local ALTCS office or call the ALTCS helpline at 888-621-6880. 

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