Arizona Medicaid (Arizona Health Care Cost Containment System) Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Arizona Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In Arizona, Medicaid is called the Arizona Health Care Cost Containment System (AHCCCS). Medicaid will help pay for long term care for Arizona residents in a nursing home, their home, the home of a loved one, an adult foster care home or an assisted living residence through one of three programs – Nursing Home / Institutional Medicaid, the Arizona Long Term Care System or Aged Blind and Disabled (ABD) Medicaid.
Arizona Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Arizona Medicaid, which is called the Arizona Health Care Cost Containment System (AHCCCS), will cover the cost of long term care in a nursing home for eligible Arizona residents who require a Nursing Facility Level of Care through its Arizona Long Term Care System (ALTCS). Arizona uses the Pre-Admission Screening tool to see if that level of care is required. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things that ALTCS won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Receiving nursing home coverage through ALTCS is an entitlement. This means that eligible Arizona residents who apply are guaranteed by law, aka “entitled,” to receive nursing home coverage through ALTCS once their application has been approved.
Any ALTCS beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $137.10/ month, as of 2023. This can be spent on personal items such as clothes, snacks, books, etc.
Arizona Long Term Care System (ALTCS)
In addition to covering nursing home care, the Arizona Long Term Care System (ALTCS) will cover long term care services and supports to assist Arizona Medicaid recipients who require a Nursing Facility Level of Care but remain living “in the community” instead of moving to a nursing home. Living “in the community” can mean living in their home, the home of a loved one, an adult foster care home or an assisted living residence. While ALTCS will provide long term care benefits in those settings, it will not cover the cost of room and board in any of those settings.
ALTCS, which is sometimes called the Elderly and Physical Disability (EPD) program, delivers its long term care services and supports, as well as its medical and behavioral health benefits, through a single plan from Arizona Medicaid, which is called the Arizona Health Care Cost Containment System (AHCCCS). These plans are provided by managed care organizations, which have a network of care providers. ATLCS program participants can choose from multiple plans, and they can also self-direct some of their care. This means they can hire caregivers from outside the managed care organization’s network, including friends and some family members.
Long term care benefits for the ALTCS program include adult day care, home modifications, medical equipment, meal delivery, housekeeping services, Personal Emergency Response Systems, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits will be made available depending on the needs and circumstances of each individual.
The ALTCS program is an entitlement. This means that all eligible applicants are guaranteed by law to receive the program benefits without any wait.
Aged Blind and Disabled / Regular Medicaid
Arizona’s Aged Blind and Disabled (ABD) Medicaid provides healthcare and personal service benefits to low-income Arizona residents who are aged (age 65+) or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages.
ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
Standard ABD Benefits
In addition to medical care, ABD Medicaid benefits can include non-medical services and supports such as in-home personal care, adult day care, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long term care benefits they need and will receive.
Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and non-medical personal needs into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. Although Arizona does not have a PACE program of its own as of 2023, there are programs in neighboring California, New Mexico and Colorado. While individuals can not transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in their new state as soon as they relocate without any waiting period. More.
Eligibility Criteria For Arizona Medicaid’s Long Term Care Programs
To be eligible for Arizona Medicaid, which is called the Arizona Health Care Cost Containment System (AHCCCS), a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Arizona Long Term Care System (ALTCS) or Aged Blind and Disabled (ABD) Medicaid.
Arizona Medicaid Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Arizona residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through the Arizona Long Term Care System (ALTCS). For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, ALTCS beneficiaries who are receiving nursing home coverage are only allowed to keep $137.10 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.
For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through ALTCS is $4,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
ALTCS applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Arizona has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through the Arizona Long Term Care System is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Arizona uses the Pre-Admission Screening tool to determine level of care requirements for Medicaid purposes. This took takes into consideration an applicant’s ability to complete the Activities of Daily Living, as well as their cognitive abilities.
Arizona Long Term Care System (ALTCS) In-Home Care Eligibility Criteria
Financial Requirements
Arizona residents have to meet an asset limit and an income limit in order to be financially eligible for coverage of long term care services and supports “in the community” (which can mean in their home, the home of a loved one, an adult foster care home or an assisted living residence) through the Arizona Long Term Care System (ALTCS).
For a single ALTCS applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single ALTCS applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2023 asset limit for long term care coverage “in the community” through ALTCS is $4,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
ALTCS applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Arizona has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for receiving long term care services in the community through the Arizona Long Term Care System is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Arizona uses the Pre-Admission Screening tool to determine level of care requirements for Medicaid purposes. This took takes into consideration an applicant’s ability to complete the Activities of Daily Living, as well as their cognitive abilities.
Arizona Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
Arizona residents have to meet an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. There are no asset limits when it comes to ABD Medicaid in Arizona, which is the only state without them.
For a single applicant in 2023, the income limit is $1,215 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. For married applicants, the 2023 income limit for Arizona ABD Medicaid is a combined $1,644 / month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.
While Arizona has a “look-back” period of five years for nursing home coverage or in-home services through the ALTCS, there is no “look-back” period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need nursing home coverage or in-home long term care through ALTCS, Nursing Home Medicaid, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The functional requirements for Arizona Aged Blind and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over). The Arizona Health Care Cost Containment System (Arizona Medicaid) will conduct an assessment of ABD Medicaid applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long term care services the beneficiary needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage / debt) is less than $688,000 (as of 2023) then the home is exempt. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $688,000. These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. More on Medicaid & Homeownership.
Applying For Arizona Medicaid Long Term Care Programs
The first step in applying for the Arizona Health Care Cost Containment System (Arizona Medicaid) Long Term Care programs is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Arizona Long Term Care System “in the community” coverage or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for the Arizona Health Care Cost Containment System (Arizona Medicaid) when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Arizona Health Care Cost Containment System applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Arizona residents can apply for long term care through the Arizona Health Care Cost Containment System by contacting their local Arizona Long Term Care System office.
Choosing an Arizona Long Term Care System Nursing Home
After an applicant has been approved for nursing home coverage through the Arizona Long Term Care System (ALTCS), they need to choose which Medicaid-approved nursing home they will live in. Even though Nursing Home Medicaid is an entitlement, ALTCS will only cover stays and care in approved nursing homes. Arizona residents can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.