Health care is vital for every individual. Because of that, the government has created programs that will help individuals who not only have disabilities but have low income and are unable to avail the necessary medical services needed.
The Arizona Long Term Care System (ALTCS) is a government program that helps less fortunate seniors and disabled individuals who are most in need of long-term care to avail of health care services. A common question asked by many residents of Arizona is what is the difference between ALTCS and AHCCCS.
What is AHCCCS?
AHCCCS, or Arizona Health Care Cost Containment System, is the agency that manages Arizona’s Medicaid and was created to provide health care to the residents of Arizona based on their ability to pay and their medical needs. AHCCCS is governed by federal and state requirements and is jointly funded by federal, state and county government monies.
The Social Security Act of 1965 created the federal Medicaid program which mandates states to provide health care to low-income families and individuals. Arizona didn’t initially participate in this program until 1982 when AHCCCS was created.
Medicaid normally adopts the “fee-for-service” payment model wherein it pays for every service directly to health care providers. AHCCCS adopts the “Mandatory Managed Care” model. In this type of payment model, it contracts health insurance that negotiate with health care providers for better rates. Instead of paying per service fees directly to health care providers, AHCCCS pays a monthly set rate to their contracted health insurances, which proves to be a more cost effective method. AHCCCS was the first state-wide managed care system in the US.
Initially, AHCCCS covered only acute care. In 1987, other programs were added such as the ALTCS to provide long-term care for the elderly and physically and developmentally disabled. In 1990, mental and behavioral health coverage were also added. In 1998, children under the age of 19 received health care coverage through the Children’s Health Insurance Program (CHIP). Over the past 40 years, AHCCCS has gone through changes in coverage and number of recipients due to availability of funds and changes in the eligibility requirements.
Know more about ALTCS.
Who’s eligible for AHCCCS?
Here are the qualifications for AHCCCS:
- Must be a resident of the state of Arizona and a US citizen;
- Must be over 65 years of age or has physical, mental or behavioral disability; and
- Should be below the limit set for gross monthly income which is $1,005 for an individual and $1,354 for a couple.
What does AHCCCS cover?
Here is the list of services an individual applying for AHCCCS may avail:
- Prescription medication
- Doctor’s office visits
- 90 days of nursing care services
- Medical supplies and equipment
- Behavioral health care
- Immunizations (shots)
- Emergency medical care
- Medically necessary transportation
- Medically necessary specialist care
- Laboratory and X-ray services
- Rehabilitation services
Covered only for children under age 21
- Vision Exams
- Dental Screening
- Dental Treatment
- Emergency Dental Care worth up to $1000 per year
- Hearing Exams
- Hearing Aids
Learn about how to apply for ALTCS.
So, what is the difference between ALTCS and AHCCCS?
ALTCS or the Arizona Long Term Care System is a part of the AHCCCS or the Arizona Health Care Cost Containment System. ALTCS, just like the Children’s Health Insurance Program or CHIP, focuses on a special group with specific needs. ALTCS caters individuals in need of long term care services.
If you are interested in taking advantage of ALTCS, you may talk to your local ALTCS office or you can talk to a consultant to discuss if you are eligible for the benefits of ALTCS and your options if in case you do not meet their conditions for eligibility.
What is ALTCS?
ALTCS is a program in the state of Arizona that was created to help low-income seniors and disabled individuals to avail long term health care services. ALTCS serves as a safety net, as it pays for the care needed when funds are depleted.
Who can take advantage of ALTCS?
In order to become eligible for its services an individual must meet the following:
- Must be a resident of the state of Arizona and a US citizen;
- Must be over 65 years of age or has physical, mental or behavioral disability after assessment by Arizona Medicaid;
- Must be in need of skilled nursing home care or an intermediate care facility;
- Should be below the limit set for the gross monthly income which is $ 2,523 a month for an individual and $ 5,046 combined a month for a couple; and
- Should be below the limit for countable assets which is $ 2,000 (This does not include exempt assets such as the house the individual is living in).
If an individual is eligible, he/she may be able to avail but not limited to the following services depending on his/her needs and where he/she resides:
- Dental Care worth up to $ 1,000 per year;
- Behavioral Health Care-Care for those who have disorders that are effects of their own behaviors;
- Adult Day Care or Respite Care-Temporary care for individuals for just a short period of time which serve as a relief and a time off for their usual caregivers;
- Home Health Care-Health care at the comfort of home;
- Medical Supplies and Equipment-Supplies and equipment essential for the recovery and well-being of an individual;
- In-Home Care-Assistance in performing daily activities at home that a person is unable to perform due to a disorder or disability;
- Health Insurance-Assistance in availing health care by just paying a certain amount of premium;
- Doctor’s Appointment-Setting schedules for a check-up with a specialist;
- Hospice Care-Care in a facility that focuses on the quality of life and not the alleviation of health conditions. This is due to the fact that these patients already have their life expectancy and are just counting their days alive; and
- Meal Delivery-Food preparation and delivery.
AHCCCS is medical coverage for low-income people, and ALTCS is for low-income individuals to pay for long-term care services.
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Steve Dabbs is a Certified Medicaid Planner™, a VA Accredited Claims, accredited by the Dept. of Veterans Affairs, and an Accredited Investment Fiduciary®. He helps people to apply and qualify for ALTCS Arizona Long-Term Care and VA Aid and Attendance Benefits.
Applying for ALTCS or VA Aid and Attendance benefits can be complicated, but Steve Dabbs can save your Time and Money by reducing delays and claims denials.
He is a Fiduciary, so as a Fiduciary, he must do what is in the best interest of his Clients.