These are a few of the most frequently asked questions we hear about the ALTCS program. There are, of course, many more facets to ALTCS benefits, eligibility criteria, and planning. If you are contemplating applying for ALTCS benefits or just concerned about affording long term care, it is imperative you seek legal advice from an experienced elder law attorney as each individual’s situation is different. With ALTCS and long term care asset protection planning there is no “cookie-cutter” approach. This blog is designed to provide general information only, and not intended to provide specific legal advice.

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 which is a health care program for the poor. ALTCS provides acute and long term care services for persons who are elderly (over age 65), physically disabled or developmentally disabled. Nationwide, the Medicaid program pays for over half of all nursing home costs.

What does ALTCS pay for?  ALTCS offers a complete array of acute medical, skilled nursing, assisted living, home health, behavioral health services, home and community based services, and case management services to all eligible persons.  See our blog from May 2 for more details on the full array of services offered. Services are coordinated and provided by an ALTCS program contractor selected by the applicant.

Who qualifies for ALTCS benefits? Unlike Medicare, eligibility for ALTCS (Medicaid) is needs based. Applicants must be medically and financially needy to qualify for benefits. In addition to meeting the medical and financial criteria, an applicant must also meet the following conditions to receive benefits:
1. Age (65 or older or under 18), blindness, or disabled;
2. Be a U.S. Citizen or lawful resident alien;
3. Be an Arizona resident (physical presence and intent to stay);
4. Must apply for all other potential benefits, such as pensions or VA benefits, and;
5. Be in an ALTCS approved type of living arrangement.

What is the ALTCS medical criteria?  Elderly or disabled applicants must be at risk of institutionalization, and require substantial assistance with activities of daily living. Medical eligibility is determined by a pre-admission screening (PAS) conducted by an AHCCCS nurse and/or social worker. The pre-admission screening consists of both a functional and medical assessment. The primary consideration is the applicant’s ability to perform his/her activities of daily living (ADL’s). These include mobility, transferring, toileting, dressing, feeding, bathing and grooming. The applicant’s diagnosis, sensory function, orientation, emotional/cognitive behavior and needed medical services and treatments are also scored. Typically, individuals who meet ALTCS medical criteria frequently present with a combination of the following needs or impairments: require skilled nursing care; require regular medical monitoring, require prompting, supervision, or hands-on assistance for ADL’s due to cognitive impairment (e.g., Alzheimer’s disease and/or dementia) or physical disability, incontinence, and/or psychosocial deficits.

What is the 2018 financial criteria?  ALTCS applicants must meet BOTH the income and resource criteria, dependent on marital status.

2018 ALTCS Income Criteria

Single persons will qualify if gross monthly income is less than $2,250.00. Married persons will qualify if the applicant spouse’s gross monthly income is less than $2,250.00, or if both spouses’ gross monthly income is less than $4,500.00.

What if the income is greater than above?   The applicant may still qualify by establishing and properly using an Income Only Trust (also known as a Miller Trust). If you require an Income Only Trust (IOT), contact our office for assistance in the preparation, funding, and administration of an IOT.

2018 ALTCS Resource Criteria

Countable Assets:  Countable assets generally consist of bank, investment, and retirement accounts, life insurance (cash value), stocks, bonds, cash on hand, and real property and/or land that is not also the applicant’s primary residence. A single applicant cannot have more than $2,000.00 in countable resources to qualify for ALTCS. The rules are more complex for a married. For a married couple, all countable assets are added together (regardless of which spouse is the owner) as of the first month the applicant spouse met medical criteria, and that total is divided in one-half. This is the allowable Community Spouse Resource Assessment (“CSRA”). Note, however, that the CSRA may not exceed the maximum of $123,600.00, or be below the minimum of $24,720.00. In addition to the half that the spouse may retain, the applicant may also retain $2,000.00 in resources. Under most circumstances, if both spouses in a marriage are applicants, then each is limited to $2,000.00 in resources.

Non-countable Assets:  Certain resources are considered excluded and therefore may be retained in addition to the allowable countable resources described above. In general, these resources include the primary residence (applicant’s interest may not exceed $572,000.00), one automobile, certain burial funds or irrevocable burial plans, burial plots, household goods and personal effects, special needs trust (established under 42 USC 1396(p)(d)(4)), and a few other items.

It is important to note that while these are the asset limits, persons whose assets exceed these limits may still be eligible with proper planning. With the advice of an experienced elder law attorney, you may be able to preserve significant assets and also qualify for ALTCS benefits to help pay for long term care costs.  Call our office to schedule an appointment if you have assets in excess of the resource limits, and would like to know how to best preserve those assets.

Will ALTCS take my house?  Not necessarily. In most instances and with proper advance planning lien and estate recovery against real property can be avoided.  ALTCS has certain limited rights to recover against the applicant’s home property, known as: (1) TEFRA lien, and (2) estate recovery program.

  • TEFRA Liens

Arizona may impose liens for ALTCS recipients of any age who are permanently institutionalized (i.e., residing in a skilled nursing facility) for at least 90 days. AHCCCS may place a lien on the recipient’s interest in real property during their lifetime, including property owned by a life estate deed and/or subject to a beneficiary deed. AHCCCS shall seek to recover the lien upon the sale or transfer of the real property subject to the lien. However, a lien may not be imposed or a claim recovered on a member’s home if any of the following individuals are lawfully residing in the home: spouse, individual’s child under the age of 21, or blind or disabled child, or an individual’s sibling (who had an equity interest in the home), and who was residing in such individual’s home for a period of at least one year immediately before the date the individual was admitted to a medical institution. In addition, AHCCCS shall not seek to recover the lien or attempt recovery against any real property subject to the lien so long as the member is survived by the member’s spouse, child under the age of 21, or disabled child. AHCCCS shall also not seek to recover a lien on an individual’s home if the member is survived by a sibling who resided in the deceased member’s home and who was residing in the home for at least one year before the member’s institutionalization, or a child resides in the home who lived there for at least two years immediately before the admission to a nursing home and provided care to the parent, which allowed the parent to reside at home rather than in an institution.

  • Estate Recovery

If a person has received services through the ALTCS program after the age of 55, then AHCCCS will have a claim to recover the cost of services rendered to that individual during his or her lifetime against assets subject to probate. ALTCS will only recover against the probate estate as defined by Arizona law and will not recover against joint tenancy property, life insurance proceeds or designated beneficiaries on pension plans or IRA’s. ALTCS will not implement any estate recovery if applicant is survived by a spouse or disabled child of any age.

If there is real estate, you should always seek advice of experienced elder law attorney to determine how best to avoid estate recovery and/or liens.

Will ALTCS decide where I will live?  No, the applicant or his legal representative will determine where the applicant resides and receives services. Note, however, that if the applicant resides outside the home, the placement selected must be an ALTCS certified living arrangement.

–Megan Selvey, Attorney at Law