Navigating Long-Term Care and the Arizona Long Term Care System (ALTCS)

Navigating Long-Term Care and the Arizona Long Term Care System (ALTCS)

Long-term care involves a range of personal, social, and medical services designed to support individuals who have lost the capacity to care for themselves, promoting dignity and independence. A common misconception is that Medicare will cover all long-term care needs; it does not.

How Long-Term Care is Paid For:

• Primarily private pay

• Long-term care insurance

• Medicare (for medical needs and limited supports)

• Medicaid (including ALTCS)

• VA Benefits (minimally)

What is ALTCS?

The Arizona Long Term Care System (ALTCS - pronounced All-Teks) is part of Arizona’s overall robust Medicaid program. It covers care for older individuals who meet financial, functional, and medical need requirements, though it does not cover everything (e.g., private rooms, hearing aids, most dental).

Eligibility at a Glance:

1. Functional/Medical Need: Measured by the Pre-Admission Screening (PAS), which assesses the need for assistance with Activities of Daily Living (ADLs) like bathing and eating. A point system is used (need 60 or higher), with cognitive impairment (diagnosed by a neurologist) heavily weighted.

2. Financial Need:

   • Income: As of the article’s date, gross income limits are around $2,901 for a single applicant and $5,963 for a married couple. Income exceeding this may require setting up an Income Only Trust (Miller Trust). Spousal income does not count against the applicant.

   • Assets: Limits are less than $2,000 for a single applicant and up to $162,660 for a married couple (without planning). Uncountable assets typically include an Arizona home, one car, and personal property.

   

Key Takeaways for Families:

• Plan Early: Do not wait until a crisis to begin planning.

• Assess Need: Schedule a free PAS through Medicaid to determine if your loved one meets the medical/functional requirements. Call the Medicaid office directly to schedule this.

• Use Professionals: Estate, financial and care planning are critical. Do not make any asset transfer or gifting decisions until you have consulted with a professional. Financial products like beneficiary deeds and spousal transfers can be used to protect assets.

• Facility Check: When selecting a care facility, ask if they accept ALTCS pending and if they have a contract that allows for backdated billing once ALTCS is active. Verify they are contracted with your specific plan (Mercy Care, United, Banner).