Arizona is a HCBS Approved State

Home care is provided by ALTCS under the Home and Community Based System.

ALTCS will pay for home care.

ALTCS and VA Pension will provide care or funding for personal care in the home. You don't! Have to be in an assisted living community or group home to qualify.

Because the two governmental programs qualification requirements are very different. In this video will focus on how ALTCS how ALTCS handles home care benefits.

If you are only interested in how the   Veterans Pension with Aid and Attendance benefit works with home care, see our website CareFundingSolutions.com/homecare or watch our video, "How to pay for Home care with Aid and Attendance benefits."

What are the ALTCS Home care benefits, and how do you qualify?
Arizona is an approved Home and Community-Based Services State or HCBS waiver state, and under the HCBS program, benefits extend and include:

  • Home daycare,
  • Personal and respite care
  • Medical transportation,
  • Mental health services,
  • Homemaker services,
  • Attendant care and home health aides.

It's important to understand that the  ALTCS  qualification requirements are precisely the same whether you stay in your home or a certified ALTCS community or group home.

The difference between being in a community or group home is the way care services are provided.

How much care is provided?

And how ALTCS treat the applicant's income?

Let's first review the ALTCS program qualification requirements.

Most know that Medicaid is a Federal program; most don't understand that the qualification requirements and benefits vary, slightly State by State. This is because it is partially funded with state funds and administered by the state.

A state's qualification requirements can be less stringent than the federal rules but not more stringent. Meaning a state's financial caseworker has to follow the federal law along with the state rules too.

Again in  Arizona, the HCBS program,  Home care is provided by our Medicaid or ALTCS, but this is not true for all states.

As I said, the Qualifications are the same, whether in a care home or community or receiving care in your own home.

Here are the three qualifications you must meet to be eligible for ALTCS.

First, you must be;

A US citizen or have resident status and have a Social Security Number.

And ba an Arizona resident.

Need nursing home level or custodial level of care as determined by AHCCCS.

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.

Unless someone is accredited, it is illegal to do so.

See carefundingsolutions.com for more information on the VA Pension with aid attendance.

So what are the Medical Requirements?

An ALTCS medical assessor who is a social worker or nurse uses a tool called the Pre-admission Screening (PAS). The PAS's purpose is to determine if the applicant has an intermediate or custodial level of care need.

They review medical records and conduct a face-to-face or over the phone interview. The applicant must score 60 points or higher to qualify.

Since the assessment is somewhat subjective, it can be redone at any time if the applicant score is less than 60 points, and the decision can also be appealed.

The assessment takes about an hour and covers a full range of medical and cognitive questions.

PAS Assessments are good for six months but can be redone at any time if the applicant does not score the needed 60 points.

The assessor looks at the person's need for assistance with activities of daily living or ADLs. These ADLs include:

  • Bathing
  • Dressing;
  • Grooming and Personal Hygiene
  • Eating and Drinking
  • Toileting
  • Mobility; and
  • Transferring;

Someone that has been diagnosed by a Neurologist with dementia is worth 20 of the 60 points needed to be approved, so having dementia alone is not enough to qualify, but it does help a lot.

One of the most significant issues with the PAS assessment process is during the live assessment when questioned. The applicant has a natural tendency to hide their health issues.

Out of pride, hide their need for assistance. For instance, someone that is incontinent will not admit it to a stranger. But Incontienance scores high on the PAS, like dementia, will go a long way to reaching the 60 points needed.

To avoid being denied, consult a Certified Medicaid Planner for assistance with the PAS process. It also may be useful to have an RN or a Board Certified Patient Advocate review your records and be at the assessment to be sure that the assessor doesn't miss score your level of care.

Next,  what are the Financial Qualification Requirements?

Since the actual dollar limits change each year, please refer to our website CareFundingSolutions.com for current amounts. We will use approximant rounded amounts for this video.

The financial qualification requirements for ALTCS, on the one hand, are reasonably straight forward, yet on the other, they can get very complicated and confusing.  Meaning, even if your income and assets are too high, several strategies can be considered, so you will qualify financially.

Seek the help of a Certified Medicaid Planner before you apply, or if you've been told your income are assets are too high to qualify.

Further, someone who is not familiar with the application process may find it difficult and ALTCS information request hard to satisfy. Being able to meet the ALTCS required deadlines; this again is why working with a competent and knowledgeable Certified Medicaid Planner is essential.

Now keep in mind regardless of Marital status, the most an applicant can have in countable assets is $2,000.  Please note that the $2000 is a hard limit; any amount above the $2000 will cause a denial.

Arizona is an "income cap" state.   If the applicant's income exceeds the income cap,  then the application will be denied. See our website for the current income cap. However, Arizona's ALTCS allows the use of an "Income Only Trust," a.k.a Miller Trust.  The Income Only Trust enables the income to flow through the Trust, making your income eligible to be approved.

To be able to use an IOT, your gross income must be below the "Gross Income Cap," which is currently over $7,500 per month.

See our video on our website:  What is an Income only Trust?

Now, here is an important rule pertaining to married couples; "All assets are jointly owned, and all income is separate."

What that rule means is the well or community spouse can have unlimited income.

This is critical to understand so let me repeat it, "All assets are jointly owned, and all income is separate." so  "The well spouse or community spouse can have unlimited income!

This is important because one of the strategies that can be employed if the total countable assets exceed the current Maximum Resource Allowance of $129,000 . Is to convert an asset to income with the use of a Medicaid Compliant Annuity.

So with the help of a Medicaid Compliant Annuity regardless of marital assets an applicant's countable assets can be converted to non-constable income.

Note that the MCA conversion strategy is usually not practical for single individuals.

Please see or website for details on the MCA and how it may work for you.

So now that you have a basic understanding what the qualification requirements for ALTCS are, lets look at the Home Care benefit and how it works.

As I mentioned early the Qualification requirements for home care are the same the difference lies in how the care is provided and how ALTCS handles the applicants income.

 

So how is care provided and how many hours of home care will ALTCS pay for? During the approval process, you are asked to choose a program manager: Currently, there are three Program Managers approved to provide this service; they are:

Mercy Care

United Health Care and

Banner Health

Once you are approved and chosen your Program Manager, you are assigned a case manager who will determine your level of care and how many hours a week of care will be allowed.

Hours approved can be as little as 10 hours a week to as much as  50 hours a week.

Here is the cool part you can have a family member be the actual caregiver and they will be paid to provide the needed care. Call us for details on how to have your family member be your PAID caregiver.

You can also have an approved home care agency provide care too.

Now, what about your income, and if married your spouse's income, how does ALTCS handle that?

If you are in a care facility, ALTCS takes all of the applicants' income, leaving them with money to pay for any Medicare Premiums and unreimbursed medical and their Individual Resource Allowance.

But if you are in your own home, you can keep 100% of your income up to the "Income Cap" ($2,349 per month)

Any income that exceeds this amount is applied to the cost of care or can be shifted to the community spouse as part of their Monthly Needs Allowance.

 

Now you can stay in your home, avoid being exposed to "THE BUG," and get the care you need.

Every case is slightly different call or text Steve Dabbs, CMP or Cecilia Dabbs, CMP.   And if your family primarily speaks Spanish,  Cecilia Dabbs is fluent in Spanish, so she can communicate with a loved one in Spanish so they can better understand.

"Se Habla Espanol."

So call Care Funding Solutions at 480-967-8477 today.

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Thank You