Arizona Medicaid – ALTCS

To ensure affordability, the State of Arizona and the Federal Government have created the Arizona Long Term Care System which in Arizona it is called (Arizona Medicaid – ALTCS), a joint initiative to help provide quality care to people with disabilities, seniors over the age of 65, and children. ARIZONA MEDICAID – ALTCS is a feature of the Arizona Health Care Cost Containment System (AHCCCS) designed to implement Medicaid insurance programs.

ALTCS is pronounced ALL-TEX.

The Medicaid insurance program is the Federal Government’s initiative to help low-income Americans, seniors, and people with disabilities. According to some estimates, 1 in 5 Americans is covered by this program.

The Medicaid program is also applicable to care within a nursing facility, rehabilitation center, assisted living facility, and residential care facility.

How does a Certified Medicaid Planner help individuals to be approved for Arizona Medicaid – ALTCS?

Certified Medicaid Planners act as an intermediary between care facility providers and applicants.

This planning team helps with legal concerns, possible cost-sharing options, paperwork, and other intricate details. Once meeting the qualification criteria, individuals can benefit from the program after completing comprehensive paperwork.

To keep the members updated with the latest developments and regulations, ARIZONA MEDICAID – ALTCS mails them a handbook annually that answers all possible queries regarding the program.

What does Arizona Medicaid – ALTCS pay for?

ARIZONA MEDICAID – ALTCS covers several home and community-based services, physical and behavioral health services, and special care for members with severe mental health concerns.

1.   Home and Community-Based Care Services:

AHCCCS – ARIZONA MEDICAID – ALTCS has a number of registered vendors which provide these kinds of services to ARIZONA MEDICAID – ALTCS members. Depending on the needs, the member may avail of these services without cost-sharing. Some of these services include:

• Day Treatment: Behavioral training, counseling for development, and sensory-motor, cognitive, and communicative training.
  
  • Behavioral Health: Whether living in a home, assisted living facility, or a nursing home, covered services include dealing with anxiety, depression, or using intoxicants: Support is offered to help members gain skills to get employed.  This also includes transition to employment and Group Supported Employment.
  • Home Modification: To help remove discomfort like barriers or make the home environment more comfortable in existing home structures.
  • Non-emergency transportation. As approved by Medicare.
  • Respite: Depending on the predetermined needs of the member, the caregiver of a member may be offered an interval of rest or relief, up to 600 hours per year.
  • Support Coordination: This service helps the member to improve physical functions[NC1]  and promotes their integration into the community. Support Coordination also ensures that appropriate and accurate services are provided, modified with time, or restricted when necessary.
  • Therapies: The program covers Occupational Therapy, Physical Therapy, and Speech Therapy, under the regulations provided in the ARIZONA MEDICAID – ALTCS handbook and the member’s ARIZONA MEDICAID – ALTCS Health Plan.
  • Home Health care and Nurse, Home Health Aide, Habilitation, and Homemaker services.

1.   Physical  Health Services:

A large number of Physical Health Services are covered under the ARIZONA MEDICAID – ALTCS, depending on the Arizona Medicaid – ALTCS Providers Health Plan of an individual member. The comprehensive list can be accessed through the member handbook or discussed with a representative. Some of the general physical health procedures covered under the program include:

Dialysis

Emergency Dental procedures

Emergency Eye examinations

HIV/AIDS Antiretroviral Therapy

Hospice

Hospital Inpatient/Outpatient visits

Immunizations

Maternity Services

Prosthetics

Medical supplies, food, equipment, or appliances

Family Planning

Physician examinations

Laboratory procedures

Physical therapy

Prescription medications

Inpatient/Outpatient occupational therapy

Inpatient/Outpatient speech therapy

Emergency/Non-emergency transportation

Triage

Respiratory procedures and therapy

1.   Behavioral Health Services:

The services covered under the program help overcome personal problems related to behavior.

These services have three steps:

Prevention, Evaluation, and Treatment. The problem is identified, discussed, and evaluated, and options and support are offered to the member to help them overpower the personal challenges.

Support Coordination provides assistance in acquiring Behavioral Health Services by referring to the relevant providers. Under the program, substance abuse and mental health issues are also dealt with. Rehabilitation services are also offered.

Service Authorization:

ARIZONA MEDICAID – ALTCS issues an approval after which a member can access the offered services. A complete health assessment is done beforehand, required treatment is prescribed, and a course of action is determined.

As a result, a Service Plan is established, a list of the authorized services the member can receive under the program, offered by the registered providers from the ARIZONA MEDICAID – ALTCS providers directory. However, the services must be proven to be necessary and also cost-effective. Once the services stated on the plan are approved, no further approval is required.

Who qualifies for the Arizona Medicaid – ALTCS benefits?

Residents of the State of Arizona can benefit from the Arizona Medicaid – ALTCS services if they qualify under the criteria. The needs of individual applicants are assessed, and their treatment is then determined.

Applicants are assessed medically and financially. Applicants have to prove that they require long-term medical care and then prove that they cannot afford the necessary care or treatment.

An application form must be completed, with possible help from a Certified Medicaid Planner. The score needs to be 60 points or above for an applicant to qualify for ARIZONA MEDICAID – ALTCS services.

What is the medical criteria?

The first step is to determine the applicant’s need for long-term care and that the applicant is at risk of institutionalization.

An appointed nurse or a certified social worker visits the applicant with family members or caregivers to conduct an interview and correctly determine the extent of care required.

This is called Pre-Admission Screening (PAS), and is conducted by the AHCCCS, as it is both a medical and functional assessment of the applicant. In case an applicant is found to be partially or fully immobile, the option for nursing home care or an assisted living facility is offered.

However, the applicant or their family is not forced to institutionalize as in-home care plans are also offered.

The extent of an applicant’s disability is also assessed. For this purpose, ARIZONA MEDICAID – ALTCS will examine medical history and additional documents to help make informed decisions. Records are also collected from the applicant’s doctor. The assessment of the applicant’s medical record also helps decide the appropriate care plan.

Applicants over age 65:

In the case of senior applicants, the eligibility criteria include:

• Age over 65
• Physical or mental disability
• Lacking ability to safely take care of themselves
• Unable to effectively conduct everyday tasks called ADLs (Activities of Daily Living), such as:
  
  • Bathing
  • Feeding
  • Ambulating
  • Transferring
  • Toileting
  • Dressing

Applicant’s hearing, vision, medical stability, acute or chronic medical conditions and prior treatments are all analyzed to check if long-term care is required under the ARIZONA MEDICAID – ALTCS. If a score of 60 points on the Senior/Physically Disabled (EPD) PAS is achieved, the applicant qualifies.

What is the financial criteria?

Income Criteria:

An individual applicant, whether single or married but applying alone, who isn’t earning more than $2,523 monthly, can be eligible.

Similarly, a married couple applying together who aren’t collectively earning more than $4,764 monthly, falls under the initial eligibility criteria.

If only one of the spouses is applying, the income of the non-applying spouse is not considered. This is measured in terms of gross income and calculated before any deductions like private health insurance or tax withholdings are deducted from the total income.

Applicants can also transfer their income to their spouses as income allowance or monthly maintenance needs allowance. There is a maximum income transfer limit of $3,425, intended to fulfill utility and shelter expenses.

This helps ensure that the non-applicant spouse does not become deprived.

Assets Criteria:

ARIZONA MEDICAID – ALTCS considers the assets of a legally married couple to be jointly owned.

Currently, asset ownership limits are set at $2,000 and $4,000 for individual applicants and couples, respectively.

In the case of one spouse being the applicant, the larger distribution of assets is allocated to the non-applicant spouse for support. For this purpose, the applicant’s spouse can keep assets up to $2,000 whereas the non-applicant spouse can hold assets up to $137,400.

This is also called Community Spouse Resource Allowance or Community Spouse Resource Education.

Income also includes pension, Social Security Disability, Social Security Retirement, SSI, wages, and 401K income.

Countable Assets:

• Savings and funds in checking accounts
• Real estate owned by the applicant (not current home) including rental property, commercial property, vacation homes, and apartments
• Credit union accounts
• Retirement account
• Assets in trust
• Promissory notes
• Life insurance policy cash value
• Stocks, bonds, investments, mutual funds, cash, cryptocurrency, and certificates of deposit
• Non-exempt vehicles such as boats

Sale of Assets:

Sale of assets, if needed, should be conducted fairly. ARIZONA MEDICAID – ALTCS, like Medicaid, has a look-back policy, which means that the finances over the past 60 months are monitored during the application process.

That includes all transfers, gift-giving, and large purchases. Just as a precaution, potential applicants should avoid conducting too many transfers in order for their application to be successfully approved.

Uncountable Assets:

• Primary home (Arizona-based) with less than equity value of $636,000 (value of home minus outstanding mortgage)
• One primary vehicle of any value
• Prepaid funeral plans
• Burial plots
• Household appliances
• Personal belongings

Excess Income or Assets:

Having income or assets above the set limits doesn’t disqualify an individual for the ARIZONA MEDICAID – ALTCS program. There are several plans and strategies which can be applied with the help of Certified Medicaid Planners to make an otherwise ineligible candidate eligible.

For example, when income is over the limit, most applicants go for the Miller Trusts, also called qualified income trusts, or income-only trusts in Arizona. In this way, the excess income is shifted into an irrevocable trust, and monthly income is kept under the Medicaid limit.

In the case of assets crossing the set limit, setting up trusts is a viable strategy, allowed by ARIZONA MEDICAID – ALTCS. Irrevocable Funeral Trusts, Long-Term Care Partnership Program, Estate Recovery Program, and Spend Down are a few of the many options available.

How can I apply for Arizona Medicaid – ALTCS?

• Visit a local Arizona Medicaid – ALTCS office.
• Call the Arizona Medicaid – ALTCS toll-free number at 1-888-621-6880.
• Fill out the Request for Application for Arizona Long Term Care System (Arizona Medicaid – ALTCS) application form and send it to the Arizona Medicaid – ALTCS office via mail or email, or drop it off in person.

But wait: over 70% of ARIZONA MEDICAID – ALTCS Applicants are denied! So before you proceed on your own consider hiring a professional to help you with the Arizona Medicaid – ARIZONA MEDICAID – ALTCS application process.

When do I need an attorney or a Certified Medicaid Planner?

Filling out the Arizona Medicaid – ALTCS application form can get tricky as there are intricate details that must be provided accurately. It can be easy if you or one of your loved ones has legal experience.

However, it is better if you get help from a Certified Medicaid Planner (CMP) for your application process to have a better chance of approval. An alternative, but costlier, option is to hire an attorney.

Applying for long-term care for yourself or a loved one is usually done during a troublesome time in life. Filling out complex details can become challenging. In fact, a large number of applications get denied because of incorrectly filled-in details and when a strategy isn’t applied to bring the income/assets under the ARIZONA MEDICAID – ALTCS prescribed limit.

An experienced professional can assist you to better navigate the application process and ensure its approval.

What happens if my parents give away or transfer excess assets to qualify for ARIZONA MEDICAID – ALTCS?

It is recommended that all prior financial transfers during the past 60 months be revealed to the ARIZONA MEDICAID – ALTCS, and no attempt should be made to conceal finances as it can make the application approval difficult.

An individual’s or spouse’s assets’ gift or transfer below the fair value must be declared. Otherwise, ARIZONA MEDICAID – ALTCS imposes a period of ineligibility upon the applicants depending on the value of the assets transferred or sold.

However, under certain circumstances, gifts/transfers are permissible and do not affect the eligibility. These include:

• Transferring to a spouse or disabled child
• Establishing a trust for a disabled child
• Transferring to a Special Needs Trust
• Gifts/transfers before the look-back period

Will ARIZONA MEDICAID – ALTCS take my house?

Generally, the property of the applicant isn’t taken by ARIZONA MEDICAID – ALTCS or AHCCCS. However, there are certain rules which allow the AHCCCS to claim an applicant’s estate.

Liens

For permanently institutionalized recipients, AHCCCS reserves the right to impose a lien on the property for up to 90 days. This applies to recipients above the age of 55 and is done to recover some of the care expenses spent on the recipient.

Certain exceptions are applicable on the recipient’s property, in which the State or AHCCCS does not impose a lien:

• If a family member resides in the house, including their spouse, child with a disability like blindness, or a minor child under the age of 21.
• A sibling who has been residing in the house since one year prior to the application submission.
• Any real property is not recovered by the AHCCCS if the deceased participant is succeeded by a spouse, a disabled child, or a minor child under the age of 21.
• Lien is not imposed or recovered if a deceased participant is succeeded by a sibling who has been residing in the house since one year prior to the participant’s institutionalization.
• Lien is not imposed or recovered if a deceased participant is succeeded by a child who has been residing in the house since two years prior to the participant’s institutionalization.

Estate Recovery

AHCCCS reserves the right to impose an estate recovery claim, over the estate of a deceased member, to make up for the amount spent on the recipient’s care beyond the age of 55.

Estate or assets outside the probate are not claimed. Additionally, if the deceased recipient is survived by a spouse or a disabled child, the estate recovery program is not imposed.

Will ARIZONA MEDICAID – ALTCS decide where I will live?

It is a common misconception that a recipient is forced to live in a certain facility. After carefully determining the medical treatment and long-term care needs, applicants are offered appropriate options.

The applicant or their legal representative decides where the applicant will reside or receive the care services. However, when choosing a private care-providing facility, to the facility must be ARIZONA MEDICAID – ALTCS-approved.

If I receive ARIZONA MEDICAID – ALTCS, will the state take over my social security and pension?

Although the ARIZONA MEDICAID – ALTCS requires the recipient to pay a certain percentage towards their long-term care, this program does not take over a recipient’s pension or social security.

How much will I have to pay for my care while on ARIZONA MEDICAID – ALTCS?

Recipients are required to pay a certain percentage of their care expenses from their income. There is not a set standard amount, and it is calculated individually for each applicant.

This is called the ‘share of cost,’ and it depends upon the recipient’s monthly income, placement type, out-of-pocket medical costs, spousal allowance, or Personal Needs Allowance (PNA).

The ARIZONA MEDICAID – ALTCS program representative will calculate the PNA and the share of the cost after analyzing the individual applicant’s case and its dynamics according to the rules set by ARIZONA MEDICAID – ALTCS.

What are my rights as an ARIZONA MEDICAID – ALTCS member?

As an ARIZONA MEDICAID – ALTCS member, the providers are required to treat you fairly with respect, regardless of your race, ethnicity, gender, religion, sexual orientation, and/or any disability. You have a right to:

• File complaints by notifying the Arizona Department of Economic Security (DES), Director’s Office of Equal Opportunity, 602-364-3976 (TTY/TDD 711), or AHCCCS, 1-855-432-7587.
• Materials that recognize your need for empathy and courtesy.
• Know about providers who speak languages other than English.
• Get interpreter services at no cost by asking your Support Coordinator or by calling 1-844-770-9500 ext. 1 (TTY/TDY 711).
• Get information, in another language or format easier to read, by calling your Support Coordinator or 1-844-770-9500 ext. 1 (TTY/TDY 711).

A complete list of the rights you have as an ARIZONA MEDICAID – ALTCS member is detailed in the official handbook.