How long does it take to get approved for ALTCS?

I am often asked about how long does it take to get approved for ALTCS. First, before I answer that, let me share a true story about one of my cases.

A daughter asked me for help on her mother’s claim. She was already medically approved by ALTCS.

Still, the ALTCS financial caseworker denied her claim because she was over the “Individual Resource Allowance.”  She had more than $2000 in countable assets.  

A new Memory Care Community had opened less than a year before in the area and required new residents to private-pay for three years before accepting  ALTCS as a payor source.

My resource partner, who helps with senior placement, told me that the same place had set aside five beds with no private pay requirements. The lifting of the private-pay requirement on those five beds was a unique opportunity for someone that otherwise could never afford to be cared for in such a beautiful setting.

So once hired by the family, I corrected the application with a couple of legal ALTCS planning strategies and reapplied for ALTCS three days later.

I got the application approved in four days, and she was able to move into that beautiful place!

I know this is hard to believe, but it is true. I was able to get it approved very quickly.

Remember that this is not the average processing time for the financial application process. I worked closely with the ALTCS financial caseworker in this situation and told her of the new memory care community and that they had set aside five beds for ALTCS with no private pay requirements. The ALTCS caseworker was terrific and helped push the case through.

A unique situation, but then all clients are unique in some way or another. For that reason, the processing time will vary from case to case. Get in depth information about Arizona Long Term Care here.

So, how long does it take to get approved for ALTCS?

ALTCS  has strict deadlines that the State agency should adhere to, notice I said should.

Under 42 CFR § 435.911., the regulations clearly state that the state agency must decide within 45 days – (90 for a disabled person, those under 65)

But wait, even though the law says 45 days, because of covid, the Covid Efficiency Waiver program gives the State of Arizona additional time.

The Covid Efficiency Waiver doesn’t apply to the applicant, only to the governmental agencies. Applicants must meet strict deadlines; if not, their claim will not be approved. 

So due to the Covid Efficiency  Waiver, the actual average for most applications is closer to 60 days or longer.

This extra time translates to money lost, your money lost!

You might like to know that our average approval is 48 days from the application date. I will explain how we reduce the processing time in most cases.

Common reasons applications are delayed and what our CMPs™ at Care Funding Solutions® do to avoid them.

Trusts Delays:

All trusts need to be reviewed by the “Policy Department” at ALTCS. This review process can take up to four weeks to complete. And they will not check anything in advance of a formal claim.

In addition, Trusts can cause additional delays besides the review process; the caseworker often asks for banking information. They can ask for up to five years of trust bank records. They can also do on all bank accounts, but this is rare for non-trust accounts, which is more common when a living trust is involved.

You can anticipate the request and begin to gather the trust banking history for five years once you decide to file a claim.

Presenting the trust: ALTCS will want a copy of the trust document, not just the “Certificate of Trust.” Including Schedule A, all amendments, and codicils.

Though not required in Arizona as part of a living trust,  ALTCS will want to see a Schedule A or Schedule of Assets. As part of our service, our Legal Document Preparer will assist in preparing an amendment to the trust and a Schedule A if your living trust doesn’t have one.

Life insurance and Annuity Values Delays:

ALTCS will require full disclosure of these contracts’ policy cash and annuity values and income. Depending on the insurance company, getting this required information can take several days to several months.

It is best to obtain this information as soon as you have decided to file for ALTCS benefits.

Here again, our office will actively assist in obtaining these needed statements and help in calling the insurance company to make the request.

Pension Benefit Delays:

ALTCS requires a current statement for all pension and annuity payment income streams.

Recently one company made this process so complicated to get the needed information that the company did not provide the information within the time deadline.

The claim was denied and had to be reopened, costing the family thousands of dollars!

It is hard to anticipate a company will be hard to work with to get the needed requirements, and this delay may be unavoidable, but in this case, it is best to start as soon as possible to shorten this delay.

Our office will actively assist in obtaining the needed statements and help in calling the pension administrators and insurance companies to make the request.

ALTCS Secret: If you are married, you may be able to have the income paid to the non-institutional spouse, at-home spouse, or sometimes called the healthy spouse. The non-institutional spouse can have unlimited income, so shifting income from the spouse needing care to the healthy spouse allows them to use it for their living expenses. This shifting of payment uses a rule called “The Name on The Check Rule.”

Not all pension administrators and annuity companies will accommodate your request, but no harm in asking. We will help in requesting this change of payee.

Veterans Benefits Delays:

Per Title 42, Medicaid / ALTCS is the payor of last resort. So if you are potentially eligible for VA benefits, you must apply for them.

Not doing so will cause your claim to be denied, which will delay the process. Not filling for VA benefits if you are eligible is Medicaid Fraud!

The VA claim doesn’t need to delay your ALTCS claim.  

First, be sure that the organization you are using to help with your ALTCS claim is also legally able to help with VA claims too.  

The Veterans Administration regulation under 38 USC § 5901 states:

“…..no individual may act as an agent or attorney in the preparation, presentation, or prosecution of any claim under laws administered by the Secretary unless such individual has been recognized for such purposes by the Secretary.”

Care Funding Solutions® owner Steve Dabbs, CMP™, is a VA Accredited Claims Agent and can expedite this process and meet the ALTCS requirement.

If denied, do I need to wait 30 days to reapply?

NO, now where in the regulations does it say that you must wait 30 days to reapply. I see this on other websites, and it’s misinformation.

You can apply the same day if you have everything ready. If ALTCS denied it because you didn’t have a requested requirement during the previous application, be sure to have it when you reapply.

Should you hire a Certified Medicaid Planner™ – CMP™?

As already mentioned, delays cost money.

ALTCS claims often go over the deadline when not monitored. A week can fly by if systems are not in place to keep track of the claim.

We have a system specifically designed to do just that in our office, which means we can keep a close eye on your claim, making the cost of our service well worth the price.

Our fee is a quarter of what a local law firm will charge for the same services.

One reason these delays cost you money is that on January 1^st, 2021, at least 12 states, including Arizona, applied and were approved for a waiver to the Federal law that eliminated the coverage from being retroactive up to 90 days.

In Arizona, if you are in Skilled-Nursing, coverage is still retroactive.

But if under the Home and Community Based Services program – HCBS Program assisted living is only retroactive back to the first of the month in the month of approval!

We will do everything possible to push the claim along to get approval before the end of the month so that month is not lost. So one day delay could cost a full 30 days and require you to pay the total cost for care for that month. 

So should you hire a CMP™, it should be self-evident. This one-month delay is easily double what it costs to hire a Certified Medicaid Planner™. So our services are, in effect, a zero net cost to you!

Here is another way we help to save you money. The applicant has 15 days to provide the needed information from the application date. The ALTCS caseworker mails or emails the requirements within 24 hours. Sometimes it takes them up to three days. Plus, if they use standard US mail to send the application requirements, it Is up to seven additional days before you receive the application and a list of needed items.

Our office helps by anticipating these potential delays and assisting clients in gathering the standard requirements needed on every application, so we do not lose this precious time that is allowed.

Then once we receive the requested items from ALTCS, we only need to add the additional ones to the file, if any, then the case is ready to submit.

The 15 days is part of the 45 days the caseworker is supposed to complete the application process. But again, they often go over that deadline.

Caseworkers at ALTCS can cost you money too! I can tell almost immediately that I have a new caseworker vs. a seasoned one!

They make incorrect statements about the Regulations that a layperson would not know are inaccurate.

An inexperienced caseworker can cause delays and even deny a claim when they shouldn’t. But if you are unfamiliar with the regulations, you don’t know that it was processed incorrectly.

If you had hired professional help from a Certified Medicaid Planner™, they would eliminate this by knowing the rules and will call their supervisor if needed to stop the errors.

As I already mentioned, 48 days is our average claim is approval time. We can AVERAGE the 48 days because we know what will be expected upfront and keep very close tabs on the application processing, including contacting the caseworker and their supervisor throughout the application process.

When deciding whether to hire a Certified Medicaid Planner™ to help you with the claims process, keep in mind that the fee charged by our office is an allowable expense for ALTCS. Our fee is part of the overall spend-down that may be required to qualify.

So as I often say, “You will spend the money anyway to qualify for  ALTCS. You might as well use some of it to hire a Certified Medicaid Planner; it will save you money in the  long run.”

At Care Funding Solutions®, 100% of our full-time staff are Certified Medicaid Planners™, effectively Certified ALTCS Planners.

Steve Dabbs is also an Accredited Investment Fiduciary® and, as a Fiduciary, must act in the client’s best interest in every aspect of what he does. He is also a VA Accredited Claims Agent and is “Legally” able to prepare, present, and prosecute a veteran claim before the Veterans Administration.

Read about what is the difference between ALTCS and AHCCCS.