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There are many facets to Arizona Long Term Care System (“ALTCS”) benefits and eligibility criteria and if you are contemplating applying for ALTCS benefits or if you are simply concerned about affording long term care needs, it is imperative you seek legal advice from an experienced attorney — there is no “cookie-cutter” approach when it comes to ALTCS.

What is ALTCS? ALTCS is part of the Arizona Health Care Cost Containment System (“AHCCCS”). AHCCCS is the state program that implements the Federal Medicaid program which is a health care program for the poor. ALTCS provides acute and long term care services for persons who are over age 65 and physically or developmentally disabled.

What does ALTCS pay for? ALTCS offers a complete array of acute medical, skilled nursing, assisted living, home health, behavioral health services, home and community based services, and case management services to all eligible persons. Services are coordinated and provided by an ALTCS program contractor selected by the applicant.

Who qualifies for ALTCS benefits? Eligibility for ALTCS (Medicaid) is needs based (unlike Medicare). Applicants must be medically and financially needy to qualify for benefits. In addition, an applicant must meet the following conditions to receive benefits:

  1. Age, blindness, or disabled;
  2. Be a U.S. Citizen or lawful resident alien;
  3. Be an Arizona resident (physical presence and intent to stay);
  4. Must apply for all other potential benefits, such as pensions or VA benefits, and;
  5. Be in an ALTCS approved type of living arrangement.

What are the medical criteria?  Elderly or disabled applicants must be “at risk of institutionalization”, and require substantial assistance with activities of daily living. Medical eligibility is determined by a pre- admission screening (PAS) conducted by an AHCCCS worker. The pre-admission screening consists of a functional and medical assessment to determine the applicant’s ability (or lack thereof) to perform activities of daily living (ADL’s): mobility, transferring, toileting, dressing, feeding, bathing and grooming. The applicant’s diagnosis, sensory function, orientation, emotional/cognitive behavior and needed

medical services and treatments are also taken into consideration. Typically, individuals who meet ALTCS medical criteria frequently present with a combination of the following needs or impairments: require skilled nursing care; require regular medical monitoring, require prompting, supervision, or hands-on assistance for ADL’s due to cognitive impairment (e.g., Alzheimer’s disease and/or dementia) or physical disability, incontinence, and/or psychosocial deficits.

What are the 2018 financial criteria? ALTCS applicants must meet BOTH the income and resource criteria, dependent on marital status.

2018 Income Criteria

Single persons will qualify if gross monthly income is less than $2,250.00. Married persons will qualify if the applicant spouse’s gross monthly income is less than $2,250.00, (or if both spouses’ gross monthly income is less than $4,500.00). If the income is greater than above, the applicant may still qualify by establishing and properly using an Income Only Trust (also known as a Miller Trust). An Income Only Trust (IOT), should be written by an attorney familiar with the ALTCS program.

2018 Resource Criteria

Countable Assets: Countable assets generally consist of bank, investment, and retirement accounts, life insurance (cash value), stocks, bonds, cash on hand, and real property and/or land that is not also the applicant’s primary residence. A single applicant cannot have more than $2,000.00 in countable resources to qualify for ALTCS. The rules are more complex for a married and all countable assets are added together (regardless of which spouse is the owner) and that total is divided in half. This is known as the Community Spouse Resource Assessment (“CSRA”). The CSRA may not exceed the maximum of $123,600.00, or be below the minimum of $24,720.00. In addition, the applicant may also retain $2,000.00 in resources. Non-countable Assets: Certain resources are considered excluded and therefore may be retained in addition to the allowable countable resources described above. In general, these resources include the primary residence (applicant’s interest may not exceed $572,000.00), one automobile, certain burial funds or irrevocable burial plans, burial plots, household goods and personal effects, special needs trust (established under 42 USC 1396(p)(d)(4)), and a few other items. It is important to note that while these are the asset limits, persons whose assets exceed these limits may still be eligible with proper planning. With the advice of an experienced elder law attorney, you may be able to preserve significant assets and also qualify for ALTCS benefits to help pay for long term care costs.

Will ALTCS take my house? Not necessarily. In most instances and with proper advance planning lien and estate recovery against real property can be avoided. ALTCS has certain limited rights to recover against the applicant’s home property, known as: (1) TEFRA lien, and (2) estate recovery program. These recovery rights can be explained by an elder law attorney who is familiar with the ALTCS program.

Will ALTCS decide where I will live? No, the applicant or his legal representative will determine where the applicant resides and receives services. If the applicant resides outside the home, the placement selected must be an ALTCS certified living arrangement.

This blog is designed to provide general information only, and not intended to provide specific legal advice.

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