In this article, we will answer the following questions about Arizona Medicaid:
- What is the Arizona Medicaid or ALTCS Application Process?
- How to apply for Medicaid in Arizona?
- Reasons Arizona Medicaid / ALTCS Applications are Denied
- What is Arizona Medicaid Eligibility 2023?
- What medical documents do I need for Arizona Medicaid?
- Reasons Applicants are denied medically for Arizona Medicaid Benefits.
- Reasons Applicants are Denied Financially for Arizona Medicaid Benefits.
- What are Arizona Medicaid Income Limits 2023?
What is Medicaid in Arizona?
Medicaid in Arizona is referred to as the Arizona Health Care Cost Containment System (AHCCCS). Another Program that provides long-term care to the elderly, the blind, and people with disabilities is called the Arizona Long Term Care System (ALTCS).
A joint state and federal health care program for low-income individuals of all ages, Medicaid is jointly funded by both. Besides nursing home care, assisted living, and adult foster care, Arizona Medicaid also provides non-medical supports to help frail seniors remain at home or live with a loved one.
Arizona Medicaid Application
There are two ways to start the Arizona Medicaid application process: Do it yourself or with the help of a Certified Medicaid Planner or attorney.
If you decide to apply for Arizona Medicaid on your own, you should know that over 79% of all Arizona Medicaid applications or ALTCS applications are denied, according to Arizona Medicaid – AHCCCS.
The high denial rate is due to the complexity of the application process.
The resulting cost for unreimbursed care cost due to denial is easily double what an attorney charges to help with the Arizona Medicaid application process and three to five times what a Certified Medicaid Planner will charge for a successful outcome.
Arizona Medicaid denials cost both time and money.
With help from a Certified Medicaid Planner with Arizona Medicaid Planning / ALTCS Planning, you can avoid having your Arizona Medicaid Application denied.
Arizona Medicaid Secret #1
Make sure you are qualified medically and financially before applying. Here is where Care Funding Solutions and their Certified Medicaid Planners can help.
How to apply for Medicaid in Arizona?
- You can physically visit your area’s Arizona Medicaid office / ALTCS office.
Keep in mind that driving to the Phoenix ALTCS Office is not convenient. Dealing with the downtown traffic and parking is a task in and of itself. Plus, with the introduction of COVID into our daily lives, many of the AHCCCS – Arizona Medicaid staff are working from their homes, so you may experience long waits if you choose this route. ( See Phoenix ALTCS office address below.)
- You can also mail a paper application to the Phoenix ALTCS office, saving them the time and trouble of personally going there and possibly being exposed to COVID. (See a sample ALTCS application here.)
- The best way is to apply over the phone by calling 888-621-6880.
When you call, tell the receptionist that you want to apply for Arizona Medicaid long-term care benefits.
In this initial call, they will ask you basic questions, which are:
Applicant’s full name
Social Security number
Date of birth
Current address where you reside
Mailing address if different from your current address
Do you have a trust?
Have you gifted any assets in the past 60 months?
Spouse’s full name
Spouse’s Social Security number
Spouse’s date of birth
You will be given an Arizona Medicaid application number at the end of the call; be sure to write it down, as having it handy will make it easier to get the application status later.
In five to seven days, you will receive a call from the financial caseworker, who will set up an appointment to go into further details about your financial situation.
If they have time and you are prepared, they will sometimes complete the questionnaire.
If not, they will set another appointment.
This phone assessment starts with confirming the information you provided when you opened the case, including your name and social security number.
The formal application is then sent for signatures and a banking and financial information request.
AHCCCS Arizona Medicaid caseworkers allow 15 days for you to return the signed application along with the requested items. This is a hard deadline; your application will be denied if you do not return the signed application and information in that allowed timeline.
Arizona Medicaid has a system that allows them to see all your banking activity.
In 2018, AHCCCS signed a contract with Accuity Asset Verification Services, Inc.
The system is called the asset verification system (AVS).
The AVS system allows an Arizona Medicaid eligibility caseworker to review your banking activity – NOT your bank statements — over the past five years or 60 months.
The system is not perfect; it only sees changes in the monthly account balances with the hope of reducing Arizona Medicaid application fraud.
The AVS system has made the Arizona Medicaid application process more difficult and time-consuming and has caused additional delays and denials.
Arizona Medicaid Secret #2
The AVS system is not 100% accurate.
If the transaction doesn’t exist, say so.
What makes things worst, the AVS system is not 100% accurate!
The AVS system inaccuracy: On more than one occasion, a caseworker has asked for account information that never existed, sometimes accounts in states other than Arizona. The burden of proof falls on the applicant to provide evidence that the account does not exist and never did.
This can be difficult, if not impossible if relating to another state. The financial institution does not share the same urgency. You still have to meet the Arizona Medicaid application required deadlines.
Here is an example of the added burden that the AVS system causes:
Both your father and mother need care due to cognitive impairment.
The AVS system identifies a series of transactions:
- $3043.34 in August 2020
- $9,320.02 in September 2020
- $4,200.12 in July 2021
- $5,602.67 in January 2022
Asking your parents if they recall these banking activities is redundant.
For that matter, can you remember all your banking transactions for the past five years?
Then you must go to a bank branch and try to get the needed information within the time allowed by Arizona Medicaid.
It gets worse when you get the bank statements. You may find that none of these transactions even exist.
The AVS system looks at each month’s beginning and ending balance over the past 60 months.
For example, look at the flagged transaction for July 2021 for $4,200.12. This total was a series of transactions that totaled $4,200.12.
One for $500, one for $1,200.12, another for $3000.00, all totaling $4,200.12.
Each transaction will require an explanation of where the money came from if it was an unusual increase in the balance, or what it was spent on if it reduced the balance.
If these were ATM transactions, it is even more challenging to provide the information Arizona Medicaid is requesting. It will likely cause the application to be denied or assessed as a penalty.
Remember that over 70% of all Arizona Medicaid applications or ALTCS applications are denied, so in this case, you just became part of the 70%!
Here is where Care Funding Solutions can help by helping to develop a response that will help reduce the penalty period or eliminate it.
Steve Dabbs has been a Certified Medicaid Planner in Arizona for over 35 years. Many people have benefited from his help in getting qualified for Arizona Medicaid ALTCS.
Minor errors cause more than 70% of applications to be denied for approval, so seeking professional help is definitely a good idea!
With Steve Dabbs’ Professional Value-Added Services, you will save Money and Time when applying for Arizona Medicaid ALTCS.
Steve literally wrote the book on this subject, which can be found on Amazon.com
“The Complete Arizona Medicaid & Veterans Pension Benefits Guide”
Call us for Free Consultation!
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.
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 2023 – 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.
- Ambulating – Walking
- Transferring – moving from bed to chair or chair to walker
The care needed must be at a nursing home level of care. Meaning full help with at least 3 ADLs for Arizona Medicaid Eligibility 2023.
What medical documents do I need for Arizona Medicaid Eligibility 2023?
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 2023 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.
Contact a Certified Medicaid Planner for Free Consultation!
Arizona Medicaid Secret #7
“If you are married;
“All assets are jointly owned. All income is separate.”
This is an important rule to remember a married couple can shift income to the spouse not needing care or the non-institutional spouse.
The spouse not needing care can have unlimited income.
Arizona Medicaid Income Limits 2023:
The Individual Resource Allowance is the most countable asset an applicant, single or married, can have in their name and still qualify.
This will vary by state.
In Arizona, the Individual Resource Allowance is currently $2000 for 2023.
This is a pretty easy requirement to meet. An applicant either has $2000 in countable assets, or they don’t. (See Countable Assets below)
A Married Couple can have a minimum of countable assets of up to $31,784 ( $2000 plus $29,784 for 2023), the Minimum Community Spouse Resource Allowance.
However, the non-institutional or non-applicant spouses can have up to $148,620. To have that amount, a married couple will have to have double that, or $297,240.
The amount is split in two. The non-institutional or healthy spouse can keep the $148,620, and the spouse needing care can only have $2000.
So the other half will have to be converted to non-countable, meaning $146,620 will need to be converted from a countable asset to a non-countable one.
Arizona Medicaid Secret #8
There are many ways to convert
a countable asset to a non-countable asset.
Understand each case is different.
Secret #8 is to hire Certified Medicaid Planner to help.
Once hired, the Certified Medicaid Planner will lay out the various options for converting a Countable Asset to a Non-Countable Asset so you will qualify.
These plans are often developed based on the CMP’s conversations with a family member to best fit the applicant’s situation. In the developed plan, I fully explain the Arizona Medicaid Income Limits 2023 in more detail and how it applies to the individual.
What is the Arizona Medicaid Countable vs. Non-Countable Assets?
Countable assets for Arizona Medicaid include:
- All marital bank savings and checking accounts (income is not an asset)
- All retirement assets, IRA, and 401 K accounts.
- Real Estate other than your primary residents.
- CDs, stocks, bonds, and Mutual Funds
- All assets titled to a Living Trust
- Valuable jewels and fine art
- Life insurance cash value above $1,500
Non-Countable assets include;
- Primary Residence
- Personal Property – Wedding Rings
- One vehicle
- Burial plots and funds up to $1,500
- Real Property for sale
- Unmarketable Property
- Term life insurance
- Irrevocable Funeral Trust Contract
- Medicaid Compliant Annuity – MCA
Single Premium Immediate Annuity
Arizona Medicaid Secret #9
Turn Countable to Non-Countable assets rather than spend-down assets on long-term care to be eligible for Arizona Medicaid / ALTCS benefits.
Spend-down assets to qualify for Arizona Medicaid is not what the smart do.
Married Couples are protected by “The Spousal Impoverishment Act.”
If married, because of the “Spousal Impoverishment Act,” CMPs have more tools and strategies that will allow a married couple to qualify and preserve nearly 100% of their otherwise countable assets, by legally converting them to non-countable.
Though there are many more Arizona Medicaid Crisis Planning options for a married couple than there are for a single individual, there are still options, if single.
I hope you have a good understanding of Arizona Medicaid income limits for 2023 now.
Will Arizona Medicaid AHCCCS take my home away?
NO! Arizona Medicaid AHCCCS will not take you home, providing you have put steps in place to protect it.
Without proper planning, Arizona Medicaid AHCCCS may try to recover what they paid for care and place a “TEFRA Lien” on the Property.
But they will not force you or your heirs to sell the Property either.
How many People in Arizona use Medicaid?
There are two parts to Medicaid, medical and long-term care. The total covered is over 2,000,000 individuals.
Of those covered, only about 8% are over 65, and only about 60% have long-term care benefits.
2021 those applying for Arizona have nearly doubled, which has put a strain on the system and the AHCCCS- ALTCS caseworkers.
This strain has created additional delays and errors by the caseworkers.
How long is the wait to find out if you get Medicaid in Arizona?
The application process is supposed only to take 45 days, but due to Covid, this timeline is closer to 60 days.
You can help to minimize the time by doing your part. Ensure you get the requested financial and medical information to the caseworker quickly and in a usable state; copies are clear and easy to read.
You provided the entire bank statement, not just a few pages; this will keep the caseworker from having to ask for them again.
Present the requested items in an orderly manner.
Order medical records yourself; doctors will respond quicker to the patient’s request for medical papers than from outside sources.
All of this will help to expedite the Arizona Medicaid Claims process.
As I mentioned, errors are not uncommon; the problem is that “Do it Yourselfers” don’t recognize a mistake when they have one made on their applications.
One such example where a married applicant who was told his income was too high to qualify. The financial caseworker combined the total household income over the $2,742 single income limit and denied the claim.
It only took me about 2 minutes to spot the error and call the supervisor to get it corrected.
I can’t think of a better example of why hiring a Certified Medicaid Planner is wise for most. The untrained would not have caught this error and went away thinking they can not qualify, when they could.
Who are MCO Organizations for Medicaid in Arizona?
As mentioned, there are two parts to Medicaid, Health Insurance coverage and Long Term Care Coverage.
Here are the Arizona Medicaid Health Insurance Providers:
- United Healthcare Community Plan
- Mercy Care Plan
- Maricopa Health Plan
- Mercy Maricopa Health Plan
- Care 1st Health Plan
- Health Choice AZ (Steward Health Choice)
- Phoenix Health Plan
- University Family Care
- Health Net
These are all managed care plans commonly known as Medicare Advantage Plans.
Long-Term Care Coverage
In Arizona, AHCCCS has chosen a managed care approach once the applicant is approved rather than micromanaging the services through the AHCCCS offices.
Arizona Medicaid Long-term care or ALTCS currently uses three Medicaid Managed Care Companies to manage the cases for those approved for long-term care coverage.
These Program Managers are:
- United Healthcare Community Plan
- Mercy Care Plan
- Banner Health
The “ALTCS Program Manager” monitors and ensures that the members of ALTCS receive appropriate and cost-effective care.
Needs are identified and managed by the Program Managers.
You must choose one of the three at the time of application. Once selected, it is difficult to change to a different ALTCS Program Manager until the anniversary of the application.
This means it is essential to choose the right one for your situation. Choosing incorrectly can be problematic.
Again, a Certified Medicaid Planner can help you make a wise choice.
Who can help file an Arizona Medicaid ALTCS Claim?
There are five types of individuals that can help file an Arizona Medicaid ALTCS Claim?
- You and your family and friends, this is the path the majority of individuals take. As I noted, the majority of claims are denied.
- Social workers often start a claim but do not assist once the application is filed. They leave that to #1 above, you.
- Non-certified application assistance companies. These people have no formal Medicaid educational training and have learned the trial and error method by helping with claims. As long as you are lucky to find a good company or individual to help, you should be ok.
- An attorney with experience with Arizona Medicaid law may be a much better option than the one, two, or three above.
The charge for an attorney will range from a low of $8000 to as much as $12,000 in Arizona for helping with Arizona Medicaid cases. So, hiring an attorney is financially prohibited for many.
Though for many, the fee is well worth the value received.
- A Certified Medicaid Planner – CMP has expert-level of experience with Arizona Medicaid.
A CMP understands the rules and regulations surrounding Arizona Medicaid and will help navigate the application processes.
A CMP, in most cases, charges just a little more than a non-certified company charges, yet much less than an attorney charges for the same services and claims outcome.
Should you hire a Certified Medicaid Planner to help with the Arizona Medicaid Application or ALTCS Application Process?
Throughout this article, I mention that you can apply for Arizona Medicaid on your own or seek professional help.
The decision to seek help obviously will depend on your situation.
Consider this if your assets are above the limit. You are spending down to qualify for Arizona Medicaid, does it not make sense to hire a professional to help?
The money is getting spent down anyway; you might as well use it to get help.
Arizona Medicaid / ALTCS Office Locations
- Arizona Medicaid / ALTCS Casa Grande Office
201 East Cottonwood Lane, Suite 2
Casa Grande, Arizona 85122
- Arizona Medicaid / ALTCS Chinle Office
Tseyi Shopping Center, Hwy. 191
Chinle, Arizona 86503
Office site only, no mail delivery.
- Arizona Medicaid / ALTCS Cottonwood Office
1500 East Cherry Street, Suite I
Cottonwood, Arizona 86326
Arizona Medicaid / ALTCS Flagstaff Office
2717 North Fourth Street, Suite 130
Flagstaff, Arizona 86004
- Arizona Medicaid / ALTCS Kingman Office
2400 Airway Avenue
Kingman, Arizona 86409
Arizona Medicaid / ALTCS Phoenix Office
801 East Jefferson Street, MD 3900
Phoenix, Arizona 85034
- Arizona Medicaid / ALTCS Prescott Office
3262 Bob Drive, Suite 11
Prescott Valley, Arizona 86314
Arizona Medicaid / ALTCS Tucson Office
7202 East Rosewood Street, Suite 125
Tucson, Arizona 85710
- Arizona Medicaid / ALTCS Yuma Office
1800 East Palo Verde Street
Yuma, Arizona 85364