Arizona and ALTCS: What is it and How Does it Help?

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.

Arizona 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 health services.

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.

Extra Tip: 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 Denied?

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 ALTCS?

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