Finding a way to pay
for the high cost of a Skilled Nursing Facility or Residential
Care Facility or even home health care for you or a loved one
can add a great deal of stress to an already difficult medical
situation. Although private pay or private insurance
are common ways to pay for this care, nationwide over 50% of
residents use some form of Medicaid to pay
for nursing home care.
Many states have created specific
programs within their federally funded Medicaid programs (for
instance, waiver programs) to help defray these costs. Some
states do not have separate waiver programs but still help cover
the costs of skilled or assisted living facilities (or home
health care) through their Medicaid program. Trying to decipher
these programs (the application requirements, the benefits of
the program as well as which homes and agencies accept the benefits)
can be difficult, confusing and
frustrating but are worth it in order to relieve financial concerns.
is one state who helps cover the cost of long term care through
their Medicaid program, ALTCS.
What is ALTCS?
ALTCS is the “Arizona Long
Term Care System” under the umbrella of the Arizona Medicaid
Program AHCCCS (Arizona Health Care Cost Containment System).
It is designed for people who are 65 years or older and/or physically
disabled or developmentally disabled and need services of a
Skilled Nursing Facility or Assisted Living Facility. Many people
on the program even live in their own home and receive in-home
Who is Eligible?
There are three parts of the
eligibility process: general, financial and medical.
General. The general requirements include being a U.S. citizen,
having Arizona residency, having a social security number and
living in an approved living arrangement (such as a participating
care facility). It is also necessary to have applied for all
potential sources of cash benefits before applying for ALTCS.
As an example, if a person is eligible for pension benefits
or VA benefits, it is necessary to apply for those potential
sources of income before becoming eligible for ALTCS assistance.
Financial. Financial requirements for single applicants include
not having more than $2,000 in “countable” resources
(the specific financial requirement changes from year to year
so this may slightly change in 2012). The limit changes for
married couples and an applicant should ask for the “Community
Spouse Information Sheet” during the application process.
Arizona’s Medicaid website has additional information
about what is considered “countable” resources (http://www.azahcccs.gov/community/Downloads/Publications/DE-828_english.pdf).
Medical. Medical eligibility is determined after financial eligibility
has been determined. A registered nurse or social worker will
visit with the applicant to determine if the person is at immediate
risk for institutionalization in a care facility.
How Do I Apply?
It will be necessary to provide
documents supporting financial and non-financial eligibility
so be prepared to gather tax documents as well as your social
security card and birth certificate. It may also be helpful
to have a loved one or other representative work on your behalf
to become eligible for ALTCS. Applications must be completed
in person through a local ALTCS office and a list of ALTCS offices
can be accessed at http://www.azahcccs.gov/applicants/application/ALTCSoffices.aspx?ID=ALTCS.
If assistance is needed with financial matters, it’s possible
to also appoint a Representative Payee through Social Security.
This can be useful when navigating the various programs available
through Social Security (or just to change an address) and can
be useful when navigating the Medicaid system although the Medicaid
system will have their own additional forms to complete in order
to appoint a representative.
What Happens if I am
Please keep in mind that more
people are denied ALTCS benefits than are approved but do not
let this be discouraging news. Mistakes are made and reversals
happen frequently. Appealing a denial is strongly encouraged.
There is a specific set of rules
for the appeals process which can bring a reversal of the denial.
It is important to know the appeal process and to follow the
instructions and timeline carefully. The ALTCS Member pamphlet,
published through the Arizona Department of Economic Security,
explains the appeal process and includes a variety of information
about the ALTCS program. (https://www.azdes.gov/InternetFiles/Pamphlets/pdf/PAD-465english.pdfs).
Which Facilities Accept
Through an informal survey of
several assisted living facilities throughout Arizona and listed
at Assisted Living Directory, approximately seventy percent
of the facilities that we asked/surveyed accept ALTCS (we were
not able to find an 'official' exact percentage on any of the
Arizona ALTCS information or government sites). In addition,
Bridgeway Health Solutions, an HMO which provides services to
those enrolled in ALTCS, lists over 400 assisted living facilities
throughout Arizona accepting ALTCS.
John Hurbon, who with his wife
runs the Arizona Skyline Assisted Living Home, LLC, accepts
ALTCS at both of their 20-bed facilities in Benson, Arizona.
John says that with both private pay and ALTCS funding, “Quality
care has to stay at a high level.” John clearly cares
for his residents and goes on to say, “We have big hearts
and we are blessed with a great staff.” John and his wife
are the kind of people you can feel comfortable caring for your
loved one. Please visit their website through the Assisted Living
Directory or at http://azskylinealh.com.
Once approved for the ALTCS
program, many care facilities are available throughout Arizona
to care for you or a loved one.
- Article by Trish
Hughes Kreis exclusively for Assisted Living Directory