There are many facets to ALTCS benefits and eligibility criteria. If you are contemplating applying for ALTCS benefits or are concerned about affording long term care, it is imperative you seek legal advice from an experienced elder law attorney because each situation is different.  Legal advice is imperative, in part, for the reason there are so many long-standing myths out there surrounding this public benefits program’s services, look-back and transfer penalty rules, estate recovery and lien rights, and more. Don’t fall into the Big Foot and Loch ness monster camp of ALTCS mythology- get the right information so you can achieve the best results! With ALTCS planning, what you don’t know really can hurt you. 

What is ALTCS?   Arizona Long Term Care System (“ALTCS”) is part of the Arizona Health Care Cost Containment System (“AHCCCS”). AHCCCS is the state program that implements the Federal Medicaid program, a health care program for low-income individuals. ALTCS provides acute and long-term care services for elderly (over age 65), physically disabled, or developmentally disabled. Medicaid pays for over half of all nursing home costs nationwide. 

What does ALTCS pay for?  ALTCS covers acute medical, skilled nursing, assisted living, home health, behavioral health services, home and community-based services, and case management services to all eligible persons. 

Who qualifies for ALTCS benefits? Check out our FAQs page for general information. Schedule a consultation with one of our elder law attorneys for specific advice to your situation. 


    1. “I’ve heard the monthly income limit to qualify for ALTCS benefits is $2,382.00 per month, and I earn more than that in Social Security and Pension so I won’t qualify.”  Not true.  Persons who earn more than the applicable income limit but less than the average cost of care (currently $7,204.78 in Maricopa, Pima, or Pinal counties, and $6,451.92 in all other Arizona counties) may still meet income eligibility criteria with use of an Income Only Trust (aka Miller Trust).  In most cases, income is not a barrier to qualifying for ALTCS. You will need, however, an elder law attorney to prepare the Income Only Trust and calculate the income to be direct deposited into the account and explain its administration.  
    2. “I have too much in assets to qualify for ALTCS benefits.” Maybe, or maybe not. There are numerous ways to “spend down” your excess assets to achieve ALTCS eligibility besides just paying for care out-of-pocket.  Typical spend-down strategies involve the reallocation of assets from countable to exempt status, gifts/transfers, payment of valid debts and expenses, and/or conversion of countable assets to a stream of income via use of Medicaid compliant annuity.  Warning: Do not attempt any spend-down strategy without legal advice as the timing and methods are critically important. 
    3. “I am married and understand that we have to first spend one-half of assets before one of us can qualify for ALTCS benefits.” Not exactly. Under ALTCS rules, the non-applicant spouse can retain up to one-half the value of the couple’s countable assets based upon what the couple owned when the ALTCS applicant met medical criteria, subject to maximum and minimum standards, plus all allowed non-countable assets.  What each married couple can keep in the form of countable assets is dependent upon their specific situation. Further, the asset planning strategies available to each couple are also dependent upon their specific circumstances.  In most instances, however, with planning we are often able to preserve much more than one-half. In fact, we have worked with married couples and been able to preserve hundreds of thousands of their hard-earned dollars through Medicaid long term care planning. 
    4. All gifts or transfer of assets create a 5-year penalty. I made a gift to my grandchild for her wedding two years ago, so I won’t be eligible for another three years.”  Not true. When applying for ALTCS benefits you must disclose all gifts or transfers of assets for less than fair market value that occurred within 5 years of application- this is commonly known as the five year look back period. The penalty period itself (number of months ALTCS will not pay for care) depends on the amount gifted/transferred and starts from the month of ALTCS application rather than the actual month of the gift/transfer. In this instance, if the wedding gift were $10,000.00 there would only be a 1.4 month penalty period beginning the month of application. Since the ALTCS application process takes several months, the penalty period would expire prior to ALTCS approval anyway. We often use gifts/transfers intentionally as part of the planning process for various purposes including but not limited to ensuing there are sufficient funds set aside to continue to privately pay for care during the application process, protecting legacy properties (e.g., family cabin), and preserving additional capital to be able to supplement the needs of the ALTCS recipient beyond their monthly personal needs allowance after they are approved for benefits and ultimately for benefit of family. Warning: Never make any gifts/transfers without specific legal advice.
    5. “ALTCS will take my house.” Not necessarily. In most instances with proper advance planning lien and estate recovery against real property can be avoided.  
    6. “ALTCS will tell me where I have to live.”  No. The ALTCS applicant or his legal representative will determine where the applicant resides and receives services. Note, if the applicant resides outside their home, the placement must be an ALTCS certified living arrangement.

If you are concerned about the cost of long-term care and want advice regarding ALTCS or need to apply now, call our office at 480-922-1010 or email to schedule an appointment to learn what you really need to know. Whether you need advance planning, help with the application process, or advice regarding post-eligibility matters we are here to help.