The high cost of long-term nursing care can shock many families, even those who believe they can afford a nursing home or other care for an older or disabled loved one. Fortunately, Arizona’s Medicaid system offers a program called the Arizona Long Term Care System (ALTCS) that can help with the cost of long-term or skilled nursing care for an older or disabled person. However, qualifying for benefits requires someone to meet various eligibility criteria, including needing nursing home-level care (whether in a facility, a community setting, or at home) and having limited income and assets.
A Scottsdale ALTCS attorney from Mushkatel, Gobbato, & Kile, P.L.L.C. can help with long-term care and Medicaid planning so you or a loved one qualify for financial assistance. With over 50 years of combined legal experience, our team can empower you to protect your rights and interests while providing the personalized attention and effort you deserve. Contact us today for a case evaluation to discuss your legal options.
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What Is ALTCS?
The Arizona Long Term Care System, a program under Arizona’s Medicaid system, provides health insurance for people with age-related health care needs or a physical disability that requires skilled nursing facility-level care. ALTCS helps them afford care from a skilled nursing facility or health care services in a home or community setting, including in senior or assisted living communities.
ALTCS and Medicaid differ from the federal Medicare program. Medicare provides health insurance for senior citizens. In contrast, ALTCS offers public assistance benefits to people with limited income and assets who need help affording home or community health care or skilled nursing care due to advanced age or disability.
What Are the Eligibility Requirements for ALTCS?
To qualify for ALTCS, an individual must meet various eligibility requirements, including:
- Being a U.S. citizen or qualified immigrant
- Residing in Arizona and having a Social Security Number
- Living at home in Arizona or residing in an Arizona assisted living or skilled nursing facility that participates in the ALTCS program
- Having applied for all available cash benefits, such as disability pensions or VA benefits
Medical Requirements
ALTCS applicants must require a nursing home level of care. This is determined through a medical screening process called the Pre-Admission Screen (PAS), which determines an applicant’s medical eligibility for benefits. The PAS involves a physical examination, review of your medical records, and evaluation of your ability to perform activities of daily living (ADLs), such as bathing, dressing, eating, and using the toilet. The PAS assigns a numerical score based on a person’s difficulty with daily activities, although most people will meet the medical eligibility criteria if they require daily assistance.
Financial Requirements
Applicants must meet financial eligibility requirements to qualify for benefits. Medicaid law sets strict income and asset limits:
- Income limits – Applicants must have a monthly income below a specific threshold, which adjusts regularly for inflation. The income requirements differ for single and married applicants.
- Asset limits – Single applicants must have less than $2,000 in assets. Limits differ for married applicants. However, the law excludes specific assets such as a primary residence, one vehicle, specific life insurance policies, and personal and household goods from the asset calculation.
ALTCS will also examine the last five years of an applicant’s financial history to see if they transferred assets to others for little or no value to reduce their assets to qualify for benefits. Examiners will count any assets transferred within the five-year lookback period and impose a corresponding penalty period that can delay the start of ALTCS benefits.
What Does ALTCS Pay For?
ALTCS can help individuals with long-term care needs afford various types of personal care and skilled nursing services, such as:
- Fees for facility care, including in nursing homes, rehabilitation facilities, or assisted living communities
- At-home care, including home health or personal care services
- Home and community services
- Preventative and acute health care services, including primary care or specialist treatment, medical tests, and prescription costs (for individuals with Medicare)
- Hospice care
- Behavioral health services
ALTCS will calculate an applicant’s Share of Cost, or the amount of money the applicant can contribute towards their health care or long-term care expenses. This number is based on the applicant’s monthly gross income, personal needs allowance, medical insurance premiums, and medical expenses not covered by ALTCS, like hearing aids or corrective lenses.
How Do I Apply for the Arizona Long Term Care System?
The Arizona Health Care Cost Containment System (AHCCCS) allows individuals to apply for ALTCS benefits by requesting an application form through a toll-free number or filling out and submitting a request form via mail, fax, email, or in person at a local ALTCS office. An applicant can designate someone as their authorized representative during the application process. Applicants must also sign an authorization form to disclose their health information to AHCCCS, which will use the applicant’s health records to determine whether they require a nursing home level of care. An application must include supporting documentation to show that an applicant meets eligibility criteria.
How Can a Scottsdale ALTCS Attorney Help Me?
Even when you require long-term care due to advanced age or disability, qualifying for ALTCS benefits can prove challenging. A Scottsdale ALTCS attorney from Mushkatel, Gobbato, & Kile, P.L.L.C. can help you or a loved one qualify for the financial assistance you need to afford necessary care by:
- Reviewing your family’s financial circumstances to determine whether you or your loved one can qualify for ALTCS
- Evaluating legal options to help you or a loved one meet the financial thresholds for benefits, including setting up Medicaid trusts
- Helping you gather the medical evidence needed to establish a need for long-term care, including medical records and testimony and reports from healthcare providers, caregivers, and medical experts
- Assisting you with filling out and submitting your application form
- Guiding you through the application process and advocating for your rights and interests at each stage
Contact a Scottsdale, AZ Long Term Care System Attorney
When a loved one requires long-term care or skilled nursing services, your family can access various Medicaid and state benefits to afford the support your loved one needs. Contact Mushkatel, Gobbato, & Kile, P.L.L.C. today for an initial consultation with an Arizona Long Term Care System attorney in Scottsdale to discuss your family’s options for seeking financial benefits and support for your loved one’s care.
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