altcs eligibility requirements 2022

What does ALTCS Stand for?

The initials “ALTCS” stands for Arizona Long-Term Care System.

It’s a program that works to help the disabled and individuals over the age of 65 with their nursing, medical and pharmaceutical expenses and provides funding for long-term care services.

ALTCS is not an insurance policy wherein you pay monthly premiums for a specified time, and then you become eligible for benefits. It is managed by the Arizona Health Care Cost Containment System (AHCCCS), the State of Arizona’s program to oversee and help implement health programs for those with low income and net worth who need long-term care.

It is designed to cater to people who have limited resources and helps provide long-term care to the disabled and seniors who need long-term care services. There are many requirements for ALTCS Eligibility.

It’s a program that helps fixed-income elderly and disabled population, who need a caregiver; but have exhausted their savings and hence cannot afford the services they need without financial aid.

But wait! It is also for the smart.

With proper planning and assistance from a Certified Medicaid Planner™, even those with above-average income and net worth can benefit from this state and federal government-funded program.

As we say at Care Funding Solutions, “Medicaid / ALTCS is not just for the poor it is for the SMART™.”

What do ALTCS benefits include?

ALTCS provides the approved applicants with a complete array of benefits. Customers must pay a share of the cost, depending on various factors.

The system pays for all their doctor-recommended procedures and medical requirements. In addition, ALTCS  provides funding for some non-medical needs, including help with their daily living activities.

ALTCS is not a one size fits all program. The type and number of services a customer may be entitled to depend upon their tailored, personalized needs.

Once  approved,  ALTCS contractors determine and help manage the person on ALTCS. 

Read Guide to ALTCS.

Currently, the approved ALTCS Providers are:

  • Banner Health 
  • Mercy Care
  • United Health

ALTCS Medical Benefits:

Under the medical expenses, ALTCS covers doctor and hospital visits, doctor-prescribed drugs, emergency dental care, medically necessary treatments administered by specialists, miscellaneous medicinal supplies, and funding to pay for required durable medical equipment.

Non-Medical Benefits:

Apart from the medical expenses, ALTCS pays for home-delivered meals and medically necessary transportation. The ALTCS also covers assistance with daily home requirements, such as laundry and groceries. ALTCS also provides caregivers to attend to the individual’s care needs and offer companionship.

Am I qualified to apply for these benefits?

For a person to qualify for ALTCS financial and medical eligibility requirements 2022, they need to fulfill some financial and medical criteria. Additionally, applicants must also meet the following requirements:

  • Applicant must be a recognized US Citizen or a Lawful Permanent Resident Alien (LPR)/Qualified Immigrant.
  • Applicants need to be a resident of Arizona.
  • Applicants need to apply for all other benefits, including potential VA benefits and Veterans pension benefits.
  • If you are a war-time veteran or surviving spouse of a qualified veteran, you must prove that you have applied for the Veteran’s Pension with Aid and Attendance benefit. I’m a VA Accredited Claims Agent, so if needed, I can Legally Prepare, Present, and Prosecute a claim for a veteran or surviving spouse.
  • Applicants must be over the age of 65 or permanently disabled.
  • If impaired, the applicant must be assessed by the AHCCCS and found to be in need of a level of care which can only be offered and provided by skilled nursing homes or other intermediate care facilities.
  • Applicant currently lives in an ALTCS approved type of living arrangement.  

Other Criterion: Medical and Financial

To ensure that the state’s resources can be utilized to help those who need it the most; applicants must fulfill the following requirements in addition to those mentioned above:

ALTCS Medical Eligibility Requirements 2022

For ALTCS medical eligibility requirements, the person applying must need a nursing home level of care. 

The applicant must need considerable assistance with their everyday activities of daily living and are found to be at an immediate/potentially immediate risk of institutionalization.

For assessing and determining medical eligibility, applicants undergo a required pre-admission screening conducted by the Arizona Health Care Cost Containment System called a PAS. The screening assesses the applicant’s medical, behavioral, comprehensive, and functional capabilities. The pre-admission screening is what determines the level of help required.

The foremost focus of the pre-admission screening is to identify if the applicant requires assistance with bathing, dressing, and overall basic acts of mobility, transferring, eating, hygiene, grooming, toileting, walking and cognitive impairment.

Most accepted applicants show difficulty performing three or more of these tasks by themselves.

  • Orientation

Do they know the people helping them, their loved ones, place and time, ability to communicate, hearing?

Moreover, the AHCCCS assesses the applicant’s sensory function, emotional wellbeing, and overall orientation as well and accounts for the level of assistance required, if any.

Generally, Medicaid or the ALTCS medical caseworkers begin the screening process by interviewing the caregivers of the applicant and reviewing their medical records. The applicants are asked basic questions to determine if they are cognitively impaired, they ask about themselves and their surroundings to understand their sense of orientation, for example, their name, age, the day of the week, etc.

The applicant is asked a series of questions like:

Where are you? What time is it? What day of the week is it? Who is the President of the United States?
(Do not help the applicant to respond)

They also ask about:

  • Medical Conditions

Hematologic/ Oncologic,  Cardiovascular, Musculoskeletal, Respiratory, Metabolic, Neurological, Genitourinary, Gastrointestinal, Ophthalmologic/ EENT, Psychiatric, Current Skin Conditions

  • Continence

Bowel and Bladder incontinence

  • Behavior issues – over the past 90 days

Wandering, Self-injurious, Aggression, Resistiveness, Disruptive Behavior

  • Services and Treatments

Physical Therapy, Occupational Therapy, Speech Therapy, Respiratory Therapy, Alcohol, and Drug Treatment

The above is used for ALTCS eligibility requirements. The applicant must score a minimum of 60 points and again must be at a nursing level of care.

This can be not very clear to most. Care Funding Solutions’, Certified Medicaid Planner,  Steve Dabbs can help. He will provide you a free medical assessment to determine your medical eligibility. 

A minimum score of 60 points is required to clear the screening process, along with the applicant’s need for a level of care a home care agency, nursing homes, or facilities can provide.

Note: The applicant doesn’t need to be receiving care when they apply; only the applicant’s need for the same is concerned.

Care Funding Solutions’, Certified Medicaid Planner™,  Steve Dabbs can help. He will provide you a free medical assessment to determine your medical eligibility. 

Steve Dabbs

Steve Dabbs

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

More than 70% of applicants find their applications getting denied for approval due to minor errors, so seeking professional help is something you should definitely consider!

Applying for ALTCS is a very complicated process but Steve Dabbs can help you to get qualified for ALTCS through his Professional Value-Added Services which will save your Money and Time.

Call us for Free ALTCS Consultation!

ALTCS Financial Eligibility Requirements 2022

ALTCS Income Limits 2022

Financial Qualifications

Medicaid / ALTCS views an applicant’s assets under two categories; countable and non-countable.

Countable Assets

Countable assets include the applicant’s bank accounts and savings, real estate properties (not including their immediate place of residence), cash value of insurance policies, assets in the form of stocks, certificate of deposits and cash, and non-exempt vehicles.

IRA’s and 401 K’s are not exempt assets, whereas, in some states, they can be.

Note that countable assets are the total marital assets. Regardless of who owns them, even if the couple has a pre-nuptial agreement in place.

Non-Countable Assets

Non-countable assets include the applicant’s home (so long as the applicant’s interest in equity in the property does not exceed $603,000).

The applicant/non-applicant spouse uses the property as a primary residence, or if a single applicant, they plan to return to the home once their health improves.

Also countable is one vehicle (no specific value required), burial plots, irrevocable burial plans, funeral trust plans, as well as personal/household possessions.

Term insurance and up to $1,500 cash value in a life insurance policy

For applicants who are single at the time of application, the net worth of their accumulated countable assets should not exceed $2,000.

Legally married applicants, on the other hand, are allowed to set aside a portion of their resources for their spouse. In this context, the spouse of the applicant is a non-applicant and thereby referred to as the’ community spouse.’

In this case, the allowed portion is the CSRA or the Community Spouse Resource Allowance.

There is a Minimum and a Maximum Community Spouse Resource Allowance.

  • Minimum Community Spouse Resource Allowance = $27,480
  • Maximum Community Spouse Resource Allowance = 137,400

As mentioned, married couple assets for Medicaid / ALTCS purposes are joint.

The Spousal Impoverishment Act was passed into law in 1988 to protect the financial security of the community spouse. Under the law, the community spouse allowed a larger share of their assets.

The maximum that the applicant can retain is $2,000. At the same time, the community spouse is allowed up to $137,400 as of January 1st, 2022.

At the same time, the community spouse is allowed to keep a minimum amount of assets which is currently $27,480.

This generally changes on an annual basis on January 1st of each year.

In case both the spouses are ALTCS applicants, they are entitled to a countable asset limit of $3,000.

For more information on the Community Spouse Resource Allowance calculation, kindly refer to the Community Spouse Resource Worksheet; for a better understanding of the procedure and its proceedings, consult with a Certified Medicaid Planner™.

Note: In case the net worth of your assets exceeds the limit, you may still be eligible to qualify for ALTCS benefits. Strategic restructuring of your investments can achieve this.

Income sources; how they’re treated?

An applicant’s income in consideration can be, amongst other things, their wages, social security, pensions, supplemental security income, immediate annuity payments, Medicaid Compliant Annuity Payments, disability income payments, and Veterans pension and compensation payments (VA aid and attendance portion is not countable)

For single applicants, the income cannot exceed $2,523 in gross monthly pay.

For married applicants (applicant and community spouse), the combined income of the couple is added and divided by 2. The resulting amount is then compared to the $2,523 income limit. In case one-half of the combined income exceeds the limit, only the applicant’s income is taken into consideration.

Example 1:  Single Applicant Income Calculation :

Applicant’s income is $2,572 per month; if single, they would need an Income Only Trust to meet the income qualification requirements for ALTCS.

Example 2:  Married Couple Income Calculation

The applicant’s income is $2,572 per month, and the Community Spouses’ income is $2,210 per month or a total of $ $4,782 per month.

Here even though the ALTCS applicant’s income is above the $2,523 income cap, the total income for both spouses is less than $5,046 there is no need for an Income Only Trust or Miller Trust to qualify for ALTCS benefits.

Example 3:  Married Couple Income Calculation

For married applicants (wherein both spouses are applying for ALTCS benefits), their combined monthly income should not exceed $5,046.

Note: In case your income is above the specified limit, you may still be eligible to qualify for ALTCS benefits. For this, you would need to allocate your excess income to an Income-Only Trust, or a.k.a Miller Trust. To better understand the procedure and its proceedings about ALTCS Eligibility, consult with a Certified Medicaid Planner™.

Example 4:  Married Couple Income Calculation

The second-way income is handled is this way; the healthy non-applicant spouse can have unlimited income, and the spouse needing extended care will qualify without an income-only trust.

Bob’s income is over $7,000 per month, and Mary’s income is only her Social Security of $722 per month.  Mary’s needs extended care and her income is well below the income cap.

She will be allowed to keep her personal needs allowance of $126.15 per month, and the balance will go to pay for her care or $602.90.

Bob, on the other hand, will be able to keep 100% of his income and is not required to pay for Mary’s care.

Understand that the spouse needing extended care’s income is still subject to the income cap and if over the cap, which currently for 2022 in Arizona is $2,523per month. And IF the household countable income is double that or $ per month, then an income-only trust or miller trust** is needed for the person applying for benefits. I hope you are now having clear understanding about ALTCS financial eligibility requirements 2022.

Frequently Asked Questions

Some common questions asked when applying for ALTCS benefits have been addressed below.

Do I need a Certified Medicaid Planner™?

While you can definitely apply for ALTCS on your own, it is recommended that you seek help from a  Certified Medicaid Planner™ or a more costly option, an attorney, to help you through the ALTCS application process.

The ALTCS application is a highly complicated process. It has many facets to it, and without help from an experienced practitioner, either a Certified Medicaid Planner™ or a costly elder law attorney, those who try to complete the process on their own tend to overlook errors that cause their application to get delayed or even denied.

Certified Medicaid Planner can help you with the best asset protection strategies. Strategies that protect your assets and maximize your chances of getting accepted in the program.

They can help you out with your medical assessments, give you financial advice and make the overall experience much smoother.

More than 70% of applicants find their applications getting denied for approval due to minor errors, so seeking professional help is something you should definitely consider!

It is understandable if you have limited resources and do not wish to spend additional money for a professional ALTCS Planner, but advice from a Certified Medicaid Planner™ can help save a lot more money in both the short and long run than if you decide to do-it-yourself.

Think of it this way. The complicated ALTCS application process is a fast-flowing river with an extremely strong current. You need to cross the river and get to the other side. While you can definitely swim to the other side and still reach the shore, would it not be better if you could get someone with a boat to help you navigate the current?

Last two points:

One: Each day that the ALTCS application is delayed cost you up to $300 per day! Divide that into the Certified Medicaid Planners™.

And if denied you are going to start all over and this could be an additional 45 day delay!

Two: The fee paid to a Certified Medicaid Planner™ , is allowed by ALTCS and is part of the spend-down process.

So I say this, you’re going to spend money to get through this process you might as well use some of the assets to hire a Certified Medicaid Planner™.

What happens if I give away or transfer my excess assets to qualify for ALTCS before app lying?

I’ve produced a series of helpful videos: “Gifting is not Illegal”,  it would be beneficial to watch this at this time.

If an ALTCS applicant is found to have transferred their resources to anyone except for their spouse, it may result in the applicant becoming ineligible for long-term care for a period of time.  

This period of time or ineligibility is determined by the amount of the gift.

At the time of application, applicants are required to disclose all gifts/ transfers of their or their spouse’s assets for a value less than the fair market value within the previous 5 years.

The calculation for determining the time of ineligibility proceeds this way:

The total asset transfer value is divided by the average monthly cost of care as decided by the ALTCS, depending on the county. Currently, this amount stands at $7,331.78 for all counties in Arizona, with the exception of Maricopa, Pima, and the Pinal Counties, wherein this amount is $8,029.46. The result of this calculation is the number of months the penalty gets imposed for, beginning at the time (month) of application.

Gifting Example:

Mary gave her Granddaughter $25,000 for college 3 years ago. The $25,000 gifted is divided by $8,029.46 which equals, ($25,000 ÷ $8,029.46 = 3.11 months) So though the application will be approved benefits will not begin for 3.11 months.

Oh, you must apply to start the penalty period.

Note: Not all transfers/gifts result in a penalty. Transfers to a spouse, disabled child (transfer may be made in the name of the child or to a specific trust for the child’s benefit), Special Needs Trust Pursuant etc are free from this legislation and are not considered. Transfers made more than 60 months prior to the time of application are also not considered.

In case you have made any such transfers, or you think you might have made any such transfers that may risk your application’s chances of approval, it is recommended that you seek professional help from a Certified Medicaid Planner™ or an experienced elderly law practitioner. 

What is ALTCS Planning or Medicaid Planning?

There are two types of planning done; these are Pre-planning and Crisis Planning.

Pre-planning is done several years before needing long-term care, whereas crisis planning is when some suddenly find themselves in need of long-term care.

Who should consider pre-planning for long-term care?  I suppose I could say, everyone.  Yet, what surprises me the most is this in 2020, only 7 percent of the U.S. population owned long-term care insurance.  

As I work with a family member in a crisis with a loved one, I often say, “Once we get your loved one approved, I would like to talk to you about your future long-term care.”

I provide them with a long-term care insurance quote and some alternative long-term care insurance products information, like annuities that take advantage of the Pension Protection Act and life insurance policies that have long-term care insurance as part of the benefits,

Later, I would contact them about these plans; with rare exceptions, they don’t no return calls, complete silence.  Being busy helping others, I move on, leaving them for the same fate as their family member with a  Long Term care Crisis in the future.

Crisis Planning

Crisis planning uses legal strategies under Title XIX and state-specific rules to convert countable assets into non-countable assets to qualify for Long-Term Care benefits. Benefits that you paid for with your taxes. 

The key to successful crisis planning is to begin as soon as the need for long-term care or possible care becomes apparent. The sooner planning begins, the more opportunities exist to obtain maximum asset preservation.

Keep in mind that the rules regarding ALTCS eligibility are complex and ever-changing; timing is crucial in the planning process. State financial caseworkers are specifically instructed not to assist in the completion of the application.

It’s essential to work with a Certified Medicaid Planner™,  CMP™.  A CMP™ understands the rules and can ensure a successful outcome of a plan.

Is planning for ALTCS legal and ethical?

Similar to federal income tax planning, planning for ALTCS is perfectly legal and ethical.

Planning for ALTCS is a strategic process to ensure that you can retain your property while getting the benefits that the state offers.

Planning for ALTCS is not hiding your resources or fooling the government. Instead, it is a simple restructuring of assets and utilization of gifts or trusts. As long as every transfer/gift is reported and everything is kept transparent, it is a hundred percent legal and ethical.

However, since proper planning requires exquisite knowledge and experience in the field, many people go about it the wrong way and end up committing errors that reduce their chances of getting accepted. In order to ensure this doesn’t happen to you, consult a Certified Medicaid Planner™, before you gift your assets.

I will leave you with this thought: Is it unethical to preserve an asset for a spouse to continue to live, set aside money for emergencies, or pay for additional needed care and comfort? A private room or non-emergency dental work?

I personally don’t believe it is, the answer it up to you to decide for yourself.

Will the ALTCS take my house?

No, but the State of Arizona Medicaid or AHCCCS reserves certain rights to make a claim towards the estate of an ALTCS applicant, but applicants generally do not lose their property.

TEFRA leins

The AHCCCS has the right to impose a TEFRA lien on the applicants property in order to recover the expenses it covered towards the customer’s care during their lifetime. This is applicable for permanently institutionalized customers over the age of 55. This property may be their home or property subject to probate.

Note: The State may not always impose a lien. There are certain exceptions to this claim which protect the individual’s assets.

For example, AHCCCS cannot impose a lien if a family member such as the applicant’s spouse, child below 21 years of age or child who has a disability are lawful residents of the property.

Applicant’s siblings with an equal interest towards the property, who have been lawful residents of the property for a minimum of 12 months before the applicant was institutionalized, are also considered.

Furthermore, AHCCCS cannot impose a lien as long as the residing family member is survived by their spouse, child below 21 years of age or child suffering from a disability.

Estate recovery program

Another way the state can make a claim towards an applicant’s estate is through the estate recovery program.

It is applicable during the probate of the applicant’s will, for deceased customers over the age of 55. AHCCCS does not have a right to this claim as long as the customer is alive. In case a family member such as the spouse or a child with disability is a lawful resident of the property, AHCCCS shall not seek to claim the estate.

To understand all of the exceptions applicable for you which can help protect your assets, it is imperative that you seek help from a Certified Medicaid Planner™.

Will the State decide where I will live?

Applicants reserve the right to determine where they are accommodated and offered services. Their place of residence may be their home or an ALTCS  certified or ALTCS Approved assisted living facility.

What exactly is an ALTCS approved assisted living facility or group care home?

An ALTCS  approved assisted living facility or group care home serves both ALTCS pay as well as private residents in their care.

Both the ALTCS pay as well as the private residents are entitled to the same rooms, beds and caregivers that the facility has to offer.

They also enjoy the same food, amenities as well as activities offered by the facilities.

Virtually, there are no restrictions separating the private pay residents from the resident on ALTCS except for one; the ALTCS pay residents are not entitled to a private room, and must share a semi-private space with another resident – unless the community or care home only has private rooms, then the ALTCS pay resident will have a private room too.

While this is certainly an ALTCS requirement, ALTCS does not mandate that the facility accommodate the individual in a semi-private room. Many ALTCS approved assisted living facilities only have private rooms and therefore allow private pay residents on ALTCS to be in a private room. Also, the family can choose to pay the additional cost for a private room.

Whether or not a private pay resident on ALTCS gets a private room to themselves is up to the facility and not the individual.

If I am eligible and qualify, will the state take over my social security and pension?

No, AHCCCS does not have a direct claim towards the applicant’s income. ALTCS customers, however, are required to pay a designated amount towards the expenses the state bears for their long-term care.

How much will I have to pay towards my long-term care?

ALTCS beneficiaries are obligated to pay a designated portion of their income for their long-term care. This amount is referred to as the “share of cost”, and is determined by the ALTCS at the time of application. The share of the cost depends on multiple factors, such as the amount of monthly Income, Personal Needs Allowance, type of accommodation, uncovered medical expenses etc.

For single customers, the share of cost is determined by taking into account all these factors. Generally, the amount is equivalent to the amount left in the customer’s income after subtracting their Personal Needs Allowance and uncovered medical expenses.

Currently, the Personal Needs Allowance for customers in a residential accommodation is $126.15, and $2,535 for those residing at home. In essence, this means that customers living at home with an income below $2,535 have to bear virtually no expenses towards their care.

For customers who are married, their spouses may be entitled to a portion of their income. This is known as the CSMIA, or Community Spouse Monthly Income Allowance. The community spouse is entitled to a minimum of $2,117.5  per month, while the maximum amount stands at $3,435 per month.

If the community spouse is below $2,177,50, they may be entitled to a draw additional funds from the customer’s income (spouse’s income on ALTCS) to cover the difference. ALTCS Financial Eligibility requirements 2022 are complex and difficult to understand without the help of a Certified Medicaid Planner.

Conclusion and Summary

Applying for ALTCS financial eligibility requirements and medical eligibility requirements is a complicated process. Even after going through every webpage on the internet that deals with ALTCS criteria, applicants make errors that cost them thousands of dollars in penalties and lost time.

While the information provided here gives you a general overall understanding of the ALTCS application approval process and proceedings, there is a multitude of facets concerning your current situation, which can only be identified by an experienced professional.

There is not a one size fits all scheme, and it is imperative that you consult a Certified Medicaid Planner™ or elder law attorney with extensive ALTCS experience before or at the time of application.

When approached correctly, ALTCS may be the perfect assistance program to cater to your needs. However, without paying attention to all the legal criteria and conditions involved, you may end up depriving yourself of the potential benefits you could have otherwise received or needlessly lose or significantly reduce your assets.

To prevent this from happening to you, contact us at Care Funding Solutions.

First and smartest way to use some of your countable assets is to hire a Certified Medicaid Planner

The fee that a CMP charges is an allowable expense by ALTCS.

See The CMP PowerTeam

Let us help you through this process!

ALTCS – Arizona’s Medicaid program is one of America’s best Medicaid Long-Term Care programs compared to other states.

Yet, even though ALTCS is better than most states qualifying for benefits can be daunting and confusing for most individuals.

Arizona’s Medicaid Long-Term Care System or ALTCS is a financial safety net for the poor.

Yet, keep in mind that the Medicaid/ALTCS program is also for the SMART!

Those who are wise can preserve assets and still have Medicaid/ALTCS pay for future care, a spouse, or a loved one. 

Even those that need care now, with the help of a Medicaid/ALTCS planning professional, can help design a plan that will protect assets and still allow some to receive benefits under the program.

Think of Medicaid/ALTCS as a long-term care insurance program that you paid for with your tax dollars.

But unlike long-term care insurance programs that you purchase from an insurance company. With Arizona’s Medicaid Program, if your income or assets are above the cap or allowance limits. You will need to do some planning to be approved. 

Arizona’s Medicaid long-term care program is a financial needs-based program (pronounced ALL-Techs or All-Tex). Keep in mind you don’t have to be impoverished to qualify. Smart people with money and incomes above the cap can also qualify for benefits too. 

The qualification requirements are three parts. Each portion must be met in order to qualify. 

These three requirements are:

  1.  Medical Requirements
  2.  Income Requirements 
  3.  Asset Requirements