Medicaid is a joint federal-state program. In 1981 the Arizona Legislature approved and funded the Arizona Health Care Cost Containment System (AHCCCS), as a prepaid, capitated managed care demonstration project under Medicaid. In 1989 Arizona Long Term Care System (ALTCS), a division of AHCCCS, was implemented offering long term care, acute care and home and community based services to the elderly or physically disabled and developmentally disabled residents of Arizona. Though the names are different, it is correct to say that ALTCS is Arizona’s version of Medicaid.

 

The medical insurance provided by AHCCCS is managed care and therefore choice in providers is limited. However, the coverage is substantial and includes, but is not limited to, the following:

• Doctor’s visits
• Dialysis
• Specialist care
• Pregnancy care
• Medical transportation
• Podiatry services
• Prescriptions
• Immunizations
• Lab and x-rays
• Physical exams
• Hospital services
• Behavioral health
• Emergency care
• Family planning

In addition to providing AHCCCS Medical Insurance, ALTCS also provides nursing home care and home and community based services, which include:

• Home Health Nursing
• Habilitation
• Adult Day Care
• Attendant Care
• Personal Care
• Respite Care
• Medical Transportation
• Home Health Aids
• Mental Health Services
• Home Delivered Meals
• Homemaker Services
• Hospice Home and Community-based Services (HCBS) may also be provided in a supervised alternative residential setting, such as an Adult Foster Care Home, Assisted Living Home, Group Home or a Level I, II, or III Behavioral Health Center.

 

 

There are both medical and financial eligibility requirements for ALTCS.

1. Medical Eligibility: To be medically eligible, an applicant must have a medical need for long term care services and be at risk of institutionalization. This means that the applicant must be in need of long term care at a level comparable to that provided in a nursing facility, but which is below that of an acute care setting (hospitalization or intense rehabilitation) and above that of a supervisory/personal care setting (intermittent outpatient medical intervention or benevolent oversight).

An individual who meets ALTCS criteria will present with one or more of the following needs and impairments:

• Requires nursing care by or under the supervision of a nurse on a daily basis
• Requires regular medical monitoring
• Exhibits impaired cognitive functioning
• Exhibits impaired self-care with activities of daily living
• Exhibits impaired continence
• Displays psychosocial deficits

2. Financial Eligibility: ALTCS looks at both the income and the resources of an applicant.

For a single person applicant, his/her gross income cannot exceed $ $2,022.00 per month.For a married couple, the total income of both spouses cannot exceed $4,044.00 per month, OR, b) The total income received by the applicant under their name as well as half of the income received in checks made out jointly in both names cannot exceed $2,022.00

The ALTCS resource limit for a single person is $2,000. For a married couple, the applicant’s spouse may retain half of the countable resources of both spouses, except the half retained cannot exceed the maximum of $109,800, and the spouse may keep a minimum of $21,912.00, even if half is less than $21,912.00. In addition to the half that the spouse retains, the applicant is still permitted to retain $2,000.00. Under most circumstances, if both spouses in a marriage are applicants then each is limited to $2,000.00 in resources.

The resources and income for both spouses are considered, regardless of community property laws or the nature of the ownership of the asset.

Certain resources, such as your home and one car, are not counted for eligibility purposes.

 

 

Yes.

A Every twelve months ALTCS re-determines financial and medical eligibility for the program.

This process is called the redetermination.

 

Many people believe once someone is eligible for ALTCS the state takes their Social Security check. This is not exactly the case. Once someone is found eligible for ALTCS, they must pay an amount towards the cost of their long term care expenses. The portion that they pay is called either “Share of Cost” or “Room and Board” depending upon the type of facility where they are living. Share of Cost and Room and Board are based upon the client’s income. ALTCS allows certain expenses to be deducted from Share of Cost. The ALTCS recipient continues to receive their Social Security check and then every month may have to write a check to the nursing home or facility for their Share of Cost or Room and Board if it is required.

 

The State of Arizona is federally mandated to recover from the probate estate of any ALTCS recipient who was 55 years of age or older when the recipient received ALTCS nursing home or HCBS services. (MS 910.1.A) The assets against which recovery is sought must be part of the probate estate. 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. Under certain circumstances an undue hardship waiver can be requested.

 

An applicant for ALTCS must disclose all uncompensated transfers (gifts) that have been made during the 36 to 60 months prior to the date of application. ALTCS then calculates a period of ineligibility by dividing the total amount transferred by the average monthly cost of care in the county. The resulting figure represents the months of ineligibility for services. The period of ineligibility runs from the date of the transfer.

Transfers are treated differently depending on the date the transfer was made and when the ALTCS application is filed. New Federal law was signed by the President on February 8, 2006 which significantly affects how transfers are treated.