Arizona Medicaid | Eligibility & Income Limits (2024)

Reasons Arizona Medicaid / ALTCS Applications are Denied:

The cause for Arizona Medicaid to deny a long-term care application varies case by case.

The two main reasons are that the ALTCS applicant is either not medically or financially eligible.

Not completing the application process within the time deadlines is the third reason that Arizona Medicaid denies most claims.

Based on my experience as a Certified Medicaid Planner or a Certified ALTCS Planner, the top reason is not being medically eligible for benefits.

At Care Funding Solutions, we can ensure you are financially eligible before filing and that the claim is on track within the deadline.

We also perform a thorough medical assessment before you apply. One of our experienced CMP’s or contracted RN will review your medical records and do a mock assessment to help determine if you or a loved one will qualify for Arizona Medicaid benefits. 

Know about “Do I need an Attorney to apply for Medicaid“.

Arizona Medicaid Secret #3

The main reason people are denied Arizona Medicaid is that someone other than the applicant or applicant’s family member starts the Arizona Medicaid application without first-hand knowledge about the applicant’s personal financial situation.

Or

In some cases, without the applicant’s knowledge!

In this case, it might be best to withdraw the application and re-apply when you are ready.

Arizona Medicaid Eligibility 2024 – Arizona Medicaid Requirements & Qualifications

What are Arizona Medicaid Medical Qualification Requirements?

You must require care or help with activities of daily living for Arizona Medicaid Medical Eligibility.

• Bathing
• Dressing
• Toileting
• Ambulating – Walking
• Transferring – moving from bed to chair or chair to walker
• Eating
• Incontinence

The care needed must be at a nursing home level of care. Meaning full help with at least 3 ADLs for Arizona Medicaid Eligibility 2024.

What medical documents do I need for Arizona Medicaid Eligibility 2024?

As part of the PreAdmission Screening assessment or PAS, the Arizona Medicaid medical assessor will request your medical records for the past three to six months and a list of prescription drugs you are taking.

They will also request a care plan from the care facility or home care company.

If you are a family caregiver, you still need to have a care plan in place that can be used for this process.

It is vital that the medical records care plan reflects the care needed.

Arizona Medicaid Secret #4

Have all your records in hand before you apply. This will speed up the approval process.

Reasons Applicants are denied medically for Arizona Medicaid :

Someone with only Dementia who can still perform all their activities of daily living will not qualify medically.

This is both confusing and frustrating for family members with a loved one that has Dementia because they can no longer live independently, and it would be best if they were in Memory Care Facility or group care home. Neither the person needing care nor the family has the money to pay for that level of care.

I hear this;  “How can that be? She can not live on their own!”

Our Certified Medicaid Planners, CMPs, can help to some degree with the PAS assessment, but of course, we cannot make someone more medically needy. It would help if you discussed the medical needs with the CMPs before you applied. Preparation is key to a successful outcome.

The PreAdmission Screening – PAS Assessment

PAS assessments have been completed on the phone over the past two years due to Covid. In contrast, before Covid, they were done live and in-person at the applicant’s location.

They begin with a statement explaining that the applicant must be at a nursing home level of care to be approved medically.

The assessment process takes about 45 minutes on average.

Here is the problem with trying to go through this on your own. “The medical assessment process is a subjective one.”

The Oxford Dictionary defines “subjective” as “based on or influenced by personal feelings, tastes, or opinions.”

Meaning you have a human being on the other end of the phone asking questions and trying to assess if the information they are getting is accurate and reliable.

Is the applicant telling the truth or exaggerating the care they need. Or on the other side, the applicant is not being realistic about the genuine care they need.

An experienced “Certified Medicaid Planner” plays a vital role here. They will prepare the applicant, caregivers, and family on what to say and what not to say.

I am not saying you should lie about the care you need; the Arizona Medicaid PAS Assessor will check the doctor’s records to ensure they match what you and the caregivers said about your health during the PAS assessment. If the doctor’s reports don’t support the PAS assessment, the Arizona Medicaid PAS assessor will not approve the application.

Arizona Medicaid Secret #5

Don’t sugarcoat the care you need and are receiving.

Or, for some, the care they should be receiving but need financial assistance to pay for it.

A common problem is during the assessment. Because of pride, the applicant will not admit they are incontinent or need help dressing and will deny they need help.

Your Certified Medicaid Planner will participate in the PAS interview listening for any discrepancy in what the applicant and caregivers are saying, like:

Example 1: An applicant says they need help to get up from a bed or chair or help to get in the shower but can go to the toilet on their own, sit down, clean themselves and get back up, which doesn’t make sense.

You might be surprised how often I have heard that exact scenario over the phone.

So I will interject myself into the Arizona Medicaid Preadmission Screening interview and point out the obvious. I will ask, “How is it that an applicant goes to the bathroom without assistance yet can not get out of a chair or bed on their own?”

Example 2: When the PAS assessor asked an applicant if they could leave the bed independently, a male applicant said “yes.” How about bath yourself? He said yes again, “I just need a little help getting in and out of the shower.”

Then asked can you ambulate on your own (walk)? He said yes with a walker.

Now, are you ready for what comes next?

“The caseworker asks if he grooms himself and brushes his teeth without help?”

He answers, “No, I have trouble getting to the bathroom and putting toothpaste on the brush.”

The caseworker let it go and didn’t question the inconsistency in the chain of questions and answers. He just said he could walk and only needed a little help to get in and out of the shower, but he can’t go to the bathroom to brush his teeth, where the battery is located.

You need 60 points from the Arizona Medicaid PreAdmission Screening PAS to be eligible; he got 44!

He’s in a skilled nursing home, he cannot live independently, and his level of care is too high for assisted living.

But he got a score of 44, unbelievable.

A different PAS assessor would have approved this case and scored over 60 points.

Above when I wrote that the PAS is a subjective process, this is what I was trying to point out.

Now he can either start over or appeal the decision, we petitioned the PAS assessment, and he got approved.

But here is the big problem: you lose time when denied; time costs money!

Each day you are not approved, receiving care costs you over $100 to as much as $350 per day if you are in skilled nursing!

At just $100 a day for 45 days, the average Arizona Medicaid application processing time represents $4,500 in out-of-pocket costs.  

Each time you are denied, Arizona Medicaid will send you a letter that tells you why your Arizona Medicaid Application was denied, so you can correct the issue(s) that caused the denial and re-apply.

I say each time because you are assigned new medical and financial caseworkers when you re-apply who will take a fresh look at your case.

Suppose they find an issue with your Arizona Medicaid application that the previous caseworker didn’t see. In that case, they will deny you the Arizona Medicaid application if you cannot explain or satisfy their request for new or additional information!

Another 45 days could be lost, which means over $9,000 in long-term care costs. And again, you apply, still paying out of pocket because you are not approved.

Now since you can only have $2000 to your name, the maximum “Individual Resource Allowance” an Arizona Medicaid applicant can have in countable assets. How do you pay the assisted living or nursing home bill when you just got denied? This is very stressful and frightening for someone in a long-term care crisis.

Read about Medicaid Compliant Annuity Arizona.

Arizona Medicaid has denied you; what is your next step?

Arizona Medicaid Secret #6

Some PAS assessments are wrongfully denied due to the subjective process of the procedure.

If that happens, you can appeal the decision.

The reason these applications are denied is apparent most of the time. A careful review of the denial letter will help determine if the application should be appealed. So the next step, with the help of a Certified Medicaid Planner, appeal it.

Other applications may need to be further developed so that they can be approved soon.

Others should never have applied for Arizona Medicaid in the first place; they are not at a high enough level of care to qualify at this time.

The Reasons Applicants are Denied Financially for Arizona Medicaid Benefits.

As a Certified Medicaid Planner, I find it difficult to understand why anyone gets denied financially for Arizona Medicaid benefits.

Unlike the medical qualification requirement, which is a subjective process, the Arizona Medicaid income limits 2024 are relatively straightforward and defined.

The only reasons you are denied financially are you are not prepared, don’t know the limits, or don’t understand the difference between a countable asset versus a non-countable asset.

But this is where a Certified Medicaid Planner plays an essential role in the process.

Many make big mistakes when it comes to asset limits. They are told if assets or income are above the limit, they do not qualify, and they do nothing. This is a big mistake, spending down assets is not your only option.

Best to have the help of a Certified Medicaid Planner to take countable assets and convert them to non-countable ones.