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ALTCS Application Assistance

Why seek ALTCS Application Assistance?

Individuals applying for ALTCS often seek ALTCS application assistance because Arizona’s Medicaid application process can be frustrating, confusing, and complicated.

Various pitfalls in the ALTCS application process can cause your ALTCS application to be denied, forcing you to re-apply. Some people even end up abandoning the process altogether.

Adding frustration to the process, the ALTCS financial caseworker uses the Account Verification System (AVS) to review banking activity for the past 60 months. The problem is that the AVS information is not 100% accurate, so the caseworkers often ask for information on transactions that never occurred, and the applicant is required to prove that they didn’t happen.

To make the process even more frustrating, the medical assessment or Pre-Admission Screening (PAS) is somewhat subjective. The ALTCS medical assessor is supposed to follow certain guidelines, but there is room for interpretation, and the assessors often interject their opinion.

Seeking ALTCS application assistance from a trained professional like a Certified Medicaid Planner™ can help sort out these financial requests and alleviate the frustrations. These professionals can help formulate an appropriate response and help with the PAS assessment, too.  

Not seeking ALTCS application assistance and guidance could be a careless and costly mistake.

The ALTCS Application Process in a Nutshell

Step 1: Prepare and present an application for ALTCS benefits. You can open up the application yourself or seek help from a spouse, family member, or Certified Medicaid Planner™ (CMP™).

Step 2: The application and attached documents are reviewed within 45 to 60 days. Applications with incomplete information or mistakes will be rejected and the claim denied.

Step 3: If the application passes the initial review, a caseworker is assigned to conduct a financial review of the application. The caseworker will determine whether the applicant’s income and assets are below the state’s limit.

Step 4: If the application passes the financial review, ALTCS will assign a medical professional to verify the applicant’s needs. The medical professional will determine whether the applicant needs help with some or all of the activities of daily living.

Step 5: After approving the application, ALTCS will ask the applicant to choose a program contractor. ALTCS doesn’t pay cash or directly provide long-term care services.

The state Medicaid agency acts through HMO companies that provide long-term care services.

Applicants must work with the program contractor to select the care plan that they need. The three program contractors under ALTCS are discussed below.

Who Is Eligible for ALTCS?

The Medicaid program covers the elderly, individuals who are disabled, and individuals in need who require help to pay for long-term care.

Although Medicaid is a federal program, it’s managed at the state level. The state authorities are empowered to enact rules to implement the program effectively.

In Arizona, the state-specific Arizona Medicaid program (also called ALTCS) falls under the control of the Arizona Health Care Cost Containment System (AHCCCS). Under the supervision of AHCCCS, Arizona Medicaid is available to all individuals who meet the residential, financial, and medical qualifications.

AHCCCS has set specific financial and medical criteria that applicants must meet. These eligibility criteria ensure that only deserving applicants most in need of governmental assistance receive the program’s benefits.

Individuals applying for Arizona Medicaid benefits must prove that their income, assets, and resources are inadequate to meet the long-term care expenses. They need to submit all relevant documents for a financial assessment.

It’s important to note that Arizona is an income cap state. When submitting the application, your income and assets must pass the financial eligibility test.

You are allowed to spend down your assets to qualify. You can also transfer the excess assets using the various transfer rules that are permitted.  

Steve Dabbs

Steve Dabbs

Steve Dabbs is a Certified Medicaid Planner in Arizona. With over 35 years’ experience, Steve Dabbs has helped many people to get qualified for ALTCS. 

Over 70% of ALTCS applicants are denied approval because of minor errors, so you should definitely consider getting professional help!

Steve Dabbs can provide you ALTCS Application Assistance through his Professional Value-Added Services that will help you to get qualified for ALTCS which will save your Money and Time. 

ALTCS Financial Eligibility 2022

There is a limit on monthly income and countable assets to qualify for ALTCS.

An unmarried person or married individual applying alone can earn up to $2523 as a monthly income and still qualify. If the applicant’s income is above $2523 and the combined income of the married couple is less than $5046, then a married applicant still qualifies.

However, either way, if the applicant’s income exceeds the limit, an Arizona Miller Trust or Income Only Trust can be used to qualify (see Arizona Miller Trust here). If the applicant’s income exceeds the cost of care, an Income Only Trust cannot be used to qualify.

Income sources that ALTCS considers when determining financial eligibility include social security benefits, remuneration (wage/salary), disability/retirement pension, supplementary security income, and similar sources.

Note that the non-institutional spouse or spouse who is not applying for ALTCS can have unlimited income. Yes, that is right: They can have unlimited income.

Countable Assets

Money invested in stocks, the value of insurance policies, the value of any real estate property or houses not used as a primary residence, and the value of a vehicle not used as the primary mode of transport are all considered countable assets.

How Does ALTCS Know What Your Asset Totals Are?

They know because you tell them as part of the application process. You must submit all financial records for all assets, whether countable or non-countable.

As previously mentioned, the AVS allows ALTCS to see banking transactions, so the application review process looks at transactions from the preceding 60 months.

Hard assets like gold and silver are challenging to uncover in the process, but not disclosing them would constitute Medicaid fraud. This could cause your application to be denied or, worse yet, you would have to pay back all the benefits paid along with penalties and fines.

In addition, making a false statement on a Medicaid application can result in a 5-year sentence for each offense.

So if you think you can hide your assets, don’t do it!

The ALTCS applicant can only have $2000 in countable assets or a $3000 maximum if both spouses are applying for benefits. For 2022, the spouse not applying for ALTCS is permitted to keep a minimum of $27,480 and a maximum of $137,400 in assets.

Some strategies can convert a countable asset to a non-countable. One easy and powerful way to convert countable assets to non-countable income is with a Medicaid Compliant Annuity.

So be sure to meet with a Certified Medicaid Planner before you assume your countable assets are too high to qualify.

Non-Financial Eligibility

The following are the non-financial requirements to qualify for ALTCS:

  • Be a U.S. citizen or qualified alien.
  • Have a Social Security number.
  • Be an Arizona resident (residency is established once in Arizona, with no plans to return to your previous state).
  • Apply for all potential benefits to which you may be entitled. (example: Veterans Pension with Aid and Attendance.)
  • Have an appropriate living arrangement. According to AHCCCS, an appropriate living arrangement includes the applicant’s home or the residence of a family member where the applicant is currently residing.

Memory care units, skilled nursing facilities, assisted living facilities, and group homes are accepted living arrangements under AHCCCS only if they are contracted to at least one of the three ALTCS program contractors.

  • Most importantly, you must require nursing-level care.

As mentioned earlier, a medical professional will be assigned to your case, and a Pre-Admission Screening (PAS) will be conducted to determine whether or not you require nursing-level care.

Medicaid or the state-specific ALTCS program is designed to provide care for individuals who cannot care for themselves. Hence, a functional assessment is a key part of the PAS.

Applicants may be eligible to receive ALTCS benefits if they suffer from dementia and/or have trouble performing activities of daily living (ADLs), such as the following:

  • bathing
  • dressing
  • eating (not cooking)
  • walking or being mobile
  • transferring (to a bed or chair and back)
  • toileting and hygiene
  • grooming

The PAS considers various aspects of your current health. Your needs are assessed, a score is assigned, and a report is prepared. To clear the PAS test, you need to receive 30 or more points, with 60 being the highest possible score.

Finally, before applying for ALTCS benefits, you must claim all other cash benefits to which you’re entitled. This normally includes pension, VA benefits (VA Aid and Attendance), etc.

The cash benefit under the VA Aid and Attendance is provided to wartime veterans or their spouses (if they meet certain conditions). Therefore if you are a veteran or surviving spouse of a veteran, you should seek ALTCS application assistance from a Certified Medicaid Planner that is also a VA Accredited Claims Agent so they can legally help you with the VA benefit portion. 

How Does the ALTCS Application Process Work?

Once you or your loved one requires long-term care, you should begin the ALTCS application process immediately as the document verification and eligibility assessment generally take 45 to 60 days. Hence, the sooner you file your application, the better.

To get started, you must complete an ALTCS application. You or your spouse, or anyone acting on your behalf, can fill out the application.

Along with the completed application, you must provide documents to prove that you meet the residential, financial, and medical eligibility requirements. Bear in mind that, at the time of application, you must already be in need of long-term care.

Once the application is completed and documents supporting the claims made in the application are ready, get in touch with the local ALTCS office. Don’t forget to include your contact information in the message you send to the local ALTCS office.

After confirming your residential status, the caseworker assigned by ALTCS will assess your financial eligibility. If you fail to meet the financial eligibility requirements, the medical evaluation will not move forward.

If your application is denied, it is best to seek professional help. You will have to use legal and accepted means to reduce resources and then apply again.

Once your financial eligibility is determined, a medical caseworker will be assigned to the case to evaluate your ability to perform activities of daily living, your medical history, and your psychological and cognitive status. As previously mentioned, you must score 30 points or more on the medical assessment (i.e., PAS) to qualify medically.

What Can I Do to Prepare Before I Apply?

Make sure you have gathered everything before you fill out the application. Summiting your request for ALTCS assistance without sufficient proof can delay the assessment process or even lead to a denial of benefits.

Along with reports of your basic medical history, you need documentation of your medical conditions that prevent you from performing activities of daily living (ADLs).

Self-reported medical difficulties with ADLs are always looked upon with skepticism by the ALTCS medical caseworkers.

You have a better chance if your health conditions are managed and documented by professional caregivers and your doctor. If a loved one is your caregiver, it will be tough to score the minimum 30 points required if the evidence of care is not in your medical records too.

Concerning financial eligibility, collect information and documents about your real estate holdings, 401(k) and pensions, burial policies, life insurance policies, certificates of deposit, money market accounts, and savings and checking accounts. Ensure that all financial statements are less than a month old when the caseworker reviews the information.

In addition, marriage certificates must be kept ready if the applicant is married.

You can qualify even if your monthly income exceeds $2,523. Before applying, you need to prepare an Income Only Trust or Arizona Miller Trust and request that all income sources be assigned to the trust.

The use of an Income Only Trust will cause the application review to take a little longer because the ALTCS policy department must review the trust in addition to the other documentation.

The application process, including assessment, will go a lot easier and faster if you have everything ready and prepared when filling out the ALTCS application.

Who Should Seek ALTCS Application Assistance?

If another individual or agency has told you that you must spend your assets on care to qualify for ALTCS coverage, you should seek ALTCS application assistance.

Spending down assets on care to qualify for ALTCS is not only a waste of money and time, but it is also entirely unnecessary with proper ALTCS planning.

I often wonder why people lead someone needing long-term care financial assistance to believe that spending down assets is the only way to qualify. The people are sharing what I call circles of misinformation and doubt.

Let’s explore the three categories of people who will say that you must spend down assets to qualify.

  1. The uninformed or inexperienced person: These individuals will say that you must spend down your assets to qualify for ALTCS if your assets are over the limit.

They make this statement because they are unfamiliar with the various strategies to convert a countable asset into a non-countable asset, allowing some to be ALTCS financially eligible.

These same individuals will say it is illegal to transfer or give away assets to qualify when this is not true.

 

  1. ALTCS caseworkers: An ALTCS financial caseworker will tell you that you must spend down, but these individuals are prohibited from giving any financial advice.

They will tell you to seek the help of an attorney or Certified Medicaid Planner.

 

As far as gifting, I had a financial caseworker once blurt out, “That’s illegal!” It happened when the ALTCS financial caseworker asked about a $24,000 transfer she saw in the AVS System, which is the system that allows ALTCS to view bank account activity. 

 

I quickly reprimanded her and told her point blank that it is not illegal to transfer assets.

 

  1. Social workers: Social workers play a significant role in providing care and emotional support to those in need of long-term care.

Social workers at hospitals and rehabilitation facilities will often start an ALTCS application for a care patient. If they learn that your assets are above the limits, some will say that you must spend down your countable assets on care to qualify.

If any of these situations have happened to you, seek ALTCS application assistance from a professional.

 

How Can I Get Help with My Application?

The previous section might lead you to falsely believe that the ALTCS application process is simple and straightforward. That’s not true.

The process is long, tricky, and frustrating for those who are not adequately prepared. The whole process, from start to finish, involves careful planning and a deep understanding of the rules and guidelines; it also requires a considerable amount of paperwork. In addition, you need the assistance of someone you can trust.

One alternative is to approach a lawyer, but that may be cost-prohibitive.

Many people consult a Certified Medicaid Planner (CMP) because of the special attention they provide to each and every case. Using a CMP offers many advantages as they assist you with the financial and medical components of the application.

They will collect the required financial and medical documents, which frees you of the cumbersome task of calling doctors and hospitals as well as visiting governmental offices to gather documents when your health is fragile.

A CMP will also analyze your current financial situation and organize your resources in ways that will increase your chances of ALTCS qualification, even before applying.

ALTCS examines your past asset transactions, often reviewing asset dealings for the previous five years. You need an expert to deal with and overcome such tricky rules.

People already needing nursing home-level care cannot afford delays caused by rejection and reapplication. Your ALTCS application can be denied even on technical bases such as simple errors, inadequate information or documents, etc.

Don’t let this happen to you. Find a Certified Medicaid Planner™ (CMP™) to start your planning and ALTCS application assistance today.

How Does ALTCS Pay for Senior Care?

Arizona Medicaid provides long-term care to beneficiaries through program contractors. No direct cash transactions happen between ALTCS and the care providers. The program contractors may pay for the long-term care services when certain conditions are met.

At present, the state Medicaid agency has contracts with three program contractors. If you live in an Arizona county that has more than one contractor, you get to choose which one suits your needs. Otherwise, you have to work with the available contractor.

ALTCS-Accepted Program Contractors

Counties

Banner University Family Care

Pima, Pinal, Gila, Maricopa, Yuma, Santa Cruz, Greenlee, Graham, La Paz, and Cochise

United Healthcare

Pinal, Gila, Coconino, Yavapai, Apache, Navajo, Mohave, and Maricopa

Mercy Care Plan

Pima, Pinal, and Maricopa

After your application is approved, you’ll be enrolled with a contractor. You can then work with your case manager to create a care plan that covers your needs.

Each program contractor has its own set of care providers (doctors, nursing facilities, caregivers, etc.). You can select the care providers from their list.

You can still use the services of a physician or caregiver not registered with your program contractor, but those services will not be covered by ALTCS. You’ll have to pay out of your own pocket for non-contracted care services.

ALTCS also covers in-home care if the caregiver is registered with your program contractor. A family member who is already providing care to the beneficiary can continue to do so. ALTCS will pay for the services provided by the family member if he or she meets the qualification of other contracted caregivers.

By seeking ALTCS Application Assistance, you will easily get qualified for ALTCS.