What is ALTCS?

Arizona Long Term Care System (“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 elderly (over age 65), physically disabled or developmentally disabled. Nationwide, the Medicaid program pays for over half of all nursing home costs.

What does ALTCS pay for?
Who qualifies for ALTCS benefits?
What is the medical criteria?
What is the financial criteria?
When do I need an attorney?
What happens if my parents give away or transfer excess assets to qualify for ALTCS?
Will ALTCS take my house?
Will ALTCS decide where I will live?
If I receive ALTCS, will the state take over my social security and pension?
How much will I have to pay for my care while on ALTCS?

What does ALTCS pay for?

ALTCS AZ 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?

Unlike Medicare, eligibility for ALTCS (Medicaid) is needs based. Applicants must be medically and financially needy to qualify for benefits. In addition to meeting the medical and financial criteria, an applicant must also meet the following conditions to receive benefits:

1. Age (65 or older or under 18), blindness, or disabled;
2. Be a U.S. Citizen or lawful resident alien

(demonstrated by birth certificate and proof of identity, unless entitled to Medicare, SSD, SSI, child receiving foster care benefits or child under the age of 1, and signed Statement of Citizenship);

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 is the medical criteria?

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 nurse and/or social worker. The pre-admission screening consists of both a functional and medical assessment. The primary consideration is the applicant’s ability to perform his/her activities of daily living (ADL’s). These include 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 scored. 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.

To download the Medical Eligibility Requirements for ALTCS, click on the link below:

Basic Medical Eligibility Requirements for ALTCS

What is the financial criteria?

ALTCS applicants must meet BOTH the income and resource criteria, dependent on marital status.

Income Criteria

Single persons will qualify if gross monthly income is less than $2,130.00. Married persons will qualify if the applicant spouse’s gross monthly income is less than $2,130.00, or if both spouses’ gross monthly income is less than $4,260.00.

What 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). If you require an Income Only Trust, be certain to seek advice of legal counsel.

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 couple where one spouse will be institutionalized. For a married couple, all countable assets are added together (regardless of which spouse is the owner) as of the first month the applicant met medical criteria, and the total is divided in one-half. This is the allowable Community Spouse Resource Assessment (“CSRA”). Note, however, that the CSRA may not exceed the maximum of $115,920.00, or be below the minimum of $23,184.00. In addition to the half that the spouse may retain, the applicant may also retain $2,000.00 in resources. Under most circumstances, if both spouses in a marriage are applicants, then each is limited to $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 $525,000.00), one automobile, certain burial funds or irrevocable burial plans, burial plots, household goods and personal effects, and a few other items.

To download the basic financial eligibility requirements for ATLCS, click on the link below:

 2013 ALTCS Financial Guidelines

When do I need an attorney?

If you or your loved one is currently receiving skilled care, assisted living, adult care home or home health care or may be in the future and you are concerned about affording such care (the average cost of nursing home care in Maricopa County is over $6,000.00 per month, and Medicare only covers up to 100 days at most) you should seek the legal advice of an attorney with knowledge and experience in Medicaid planning.
More specifically, you should seek advice of counsel in the following circumstances:

1. You need an Income Only Trust (also known as a Miller Trust);
2. You own real property;
3. You have any amount of “excess” countable resources;

4. You are considering making any gift/transfer of assets, or the ALTCS applicant has made a gift/transfer in the last 5 years;
5. You have already submitted an ALTCS application, and were denied; or,

6. The ALTCS applicant is married and preservation of assets is desirable to provide for the “well-spouse”.

FREQUENTLY ASKED QUESTIONS:

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

A person who gives or transfers an asset for less than fair market value 5 years prior to applying for AZ ALTCS must disclose the gift/transfer at time of application; this is known as the “look back period”. The actual penalty, or number of months the applicant will be ineligible for services depends on the value of the gift/transfer. AHCCCS then calculates a period of ineligibility by dividing the total amount transferred by the average monthly cost of care in the county as determined by ALTCS, which is currently $6,481.94 in Maricopa, Pima, or Pinal Counties, and $5,688.34 in all other Arizona counties. The resulting figure is the number of months of ineligibility, beginning the month of application.

Will ALTCS take my house?

Not necessarily. ALTCS has certain limited rights to recover against the applicant’s home property: (1) TEFRA lien, and (2) estate recovery program.

Liens

Arizona may impose liens for ALTCS recipients who are age 55 or older, and who are permanently institutionalized (i.e., residing in a skilled nursing facility) for at least 90 days. AHCCCS may place a lien on the recipient’s interest in real property during their lifetime, including property owned by a life estate deed and/or subject to a beneficiary deed. AHCCCS shall seek to recover the lien upon the sale or transfer of the real property subject to the lien. However, a lien may not be imposed or a claim recovered on a member’s home if any of the following individuals are lawfully residing in the home: spouse, individual’s child under the age of 21, or blind or disabled child, or an individual’s sibling (who had an equity interest in the home), and who was residing in such individual’s home for a period of at least one year immediately before the date the individual was admitted to a medical institution. In addition, AHCCCS shall not seek to recover the lien or attempt recovery against any real property subject to the lien so long as the member is survived by the member’s spouse, child under the age of 21, or disabled child. AHCCCS shall also not seek to recover a lien on an individual’s home if the member is survived by a sibling who resided in the deceased member’s home and who was residing in the home for at least one year before the member’s institutionalization, or a child resides in the home who lived there for at least two years immediately before the admission to a nursing home and provided care to the parent, which allowed the parent to reside at home rather than in an institution.

Estate Recovery

If a person has received services through the ALTCS program after the age of 55, then AHCCCS will have a claim to recover the cost of services rendered to that individual during his or her lifetime against assets subject to probate. ALTCS will only recover against the probate estate as defined by Arizona law and will not recover against joint tenancy property, life insurance proceeds or designated beneficiaries on pension plans or IRA’s. ALTCS will not implement any estate recovery if applicant is survived by a spouse or disabled child of any age.

May I purchase non-countable assets to “spend down” the excess assets?

Yes, you may pay off debts and purchase non-countable assets in order to spend down to your countable resource limit.

Will ALTCS decide where I will live?

No, the applicant or his legal representative will determine where the applicant resides and receives services. Note, however, that if the applicant resides outside the home, the placement selected must be an ALTCS certified living arrangement.

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

No, the state does not literally take over your monthly income or accounts. The ALTCS program rules will, however, prescribe how much is required to be paid in share of cost, room and board, out of pocket medical expenses, spousal allowance (if applicable), and/or spending allowance.

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

ALTCS requires the recipient to contribute to his own cost of care. Nursing home residents are allowed to keep a personal needs allowance ($106.50), pay out of pocket medical expenses (e.g., insurance premiums, prescriptions, co-pays), and then pay spousal allowable (if applicable) as calculated by AHCCCS. The remaining monthly income, if any, shall be the share of cost paid to the skilled nursing facility.
If the applicant resides at home, he/she will be entitled to keep $2,130.00 as a personal needs allowance. A share of cost will not be assessed at all if the applicant receives services in the home, unless, perhaps, if an income only trust has been established. An individual residing in an alternative living arrangement (e.g., adult care home or assisting living community) will be required to pay a portion of their costs as “room and board” to be determined by the program contractor. The share of cost calculation does not take into consideration the ALTCS recipient’s other bills, including child support, spousal maintenance or other court-ordered amounts.

At Bivens & Associates, P.L.L.C., we have helped hundreds of clients for over 10 years protect and preserve their hard-earned assets while ensuring they receive quality care.

Options for Long Term Care Funding