Medicaid Eligibility for Seniors in Arizona in 2021
Arizona Long Term Care System (ALTCS)
Arizona’s long term care Medicaid program is also known as the Arizona Long Term Care System or with the acronym ALTCS. ALTCS is designed for people who are medically needy but cannot afford the care they need to remain healthy and safe. Applicants must meet certain medical requirements as well as income and asset requirements.
Arizona is an income cap state, meaning that in order to be eligible for Medicaid long term care, there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.
Like many other states, Arizona sets their income limit at 300% of the Federal Benefit Rate. The exact dollar amount changes annually. If an applicant’s income is higher than the state’s limit, an income only trust must be created for any excess income above the maximum.
ALTCS Program Description:
Arizona’s Medicaid Program provides payment for special long-term care support services, as well as full Medicaid health coverage, to eligible people who, because of their medical conditions, require assistance with activities of daily living (eating, bathing, dressing, grooming, transferring, etc.). Long-term care supports may be provided either in a facility or in an individual’s home. If care is desired in a facility, the facility must be contracted with ALTCS to provide care. There are no state-run facilities, but rather private facilities and residential group homes that contract with ALTCS to accept Medicaid as a form of payment. This allows for a wide variety of choices for ALTCS members.
For those who prefer to receive care at home, ALTCS will pay for up to 40 hours of care per week. Another benefit of remaining in home, is that in most cases, a person will be able to keep 100% income of their while still receiving ALTCS benefits.
Who is Eligible for ALTCS?
1. Residency and Citizenship – the applicant must be a resident of Arizona and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,382/month to become eligible for Medicaid. Income that is not considered countable includes a personal needs allowance ($119.10/month per individual). Persons with income in excess of $2,382 can still qualify for Medicaid coverage if excess income is placed into a Miller Trust. The trust must be irrevocable and Arizona Medicaid must be the designated recipient when the beneficiary dies.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits.
The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an ALTCS Applicant Include:
- $2,000 or less in cash/non-exempt assets if single. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
- One home is exempt (equity limit $603,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
- One automobile, no equity amount specified.
- Burial spaces/plots and irrevocable burial funds, with a value of $1,500 or less.
- Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
- Value of life insurance if face value is $1,500 or less.
ALTCS Spousal Rules:
Amount of assets community spouse may retain: The community spouse in 2021 can keep non-exempt resources owned by one or both spouses with a maximum of $130,380. If the community spouse’s assets do not equal the minimum of $26,076, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection in 2021: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,155. The maximum amount of income that can be retained is $3,259.50/month varying by case, depending on unique living expenses.
Arizona Long Term Care Insurance Partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
ALTCS Benefits and Coverage:
ALTCS coverage varies based on where a person is living. For example, if a person resides in a long-term care facility, they will receive different long-term care supports than a person who remains at home. Depending on income level, medical neediness, and where the person lives, an ALTCS recipient may receive some or all of the following services:
- If Applicable, Behavioral Health Care
- Up to $1,000/year in Dental Care
- Adult Day Care or Respite Care
- Home Health Services
- Medical Supplies and Durable Medical Equipment
- In-home Caregiving
- Long-Term Care Facility Payments
- Health Insurance
- Medicaid Insurance
- Doctor’s Appointments
- Hospice Care
- Meal Delivery
Getting Paid as a Family Caregiver
Beyond paying for care at an approved long term care facility or paying for a professional caregiver, ALTCS can also pay a family member to provide in-home care. ALTCS will pay up to 40 hours a week of care, depending on medical necessity. When paying a family member as a caregiver, the ALTCS recipient is allowed to keep all of their income as long as it is below the ALTCS limit. Essentially, this means the family caregiver is paid entirely by the state unless the ALTCS recipient chooses to pay them for extra services out of their own pocket.
How Long Does the ALTCS Application Take?
Generally, if everything is a submitted on time and there are no hiccups, the Arizona Medicaid application will take between 60-90 days from start date until approval. For applications that require the use of a Miller Trust, processing time will increase. A Miller Trust is necessary if an applicant is over the ALTCS income limit, but still needs benefits to help pay for their care. Senior Planning can assist with the creation of a Miller Trust, sometimes called an Income Only Trust.
Does Medicare Pay for Long Term Care in Arizona?
In a word, no. Medicare is not designed to pay for long-term care beyond a qualified stay at a rehabilitation center or a short term stay at a skilled nursing facility (SNF). For individuals who need care longer than 100 days per Medicare pay period, or for individuals who have not been hospitalized but still need long term care, ALTCS is the Arizona program you need. For veterans in need of long term care, there might be other benefits available on top of ALTCS.
Can Someone Apply to ALTCS for Me?
Yes. Arizona Medicaid allows each applicant to have what is called a personal representative to help them through the application process. A personal representative can be a friend, family member, or even a paid representative. Because the ALTCS application is many people’s first time applying for state benefits, the process can become extremely complicated. Errors or failure to submit correct documentation can result in delays or denial of the application. Also, if a person is over assets or over income and application will be denied immediately. This is why many Arizonans choose to enlist the help of a professional. Call Senior Planning today for a free consultation to learn how we might be able to help you. If you believe you have been denied coverage that you think you are entitled to receive give us a call and we can assess where the application might have gone wrong.
Senior Planning’s dedicated website for long term care planning: https://www.altcs.com