Practice Areas-Long Term Care (ALTCS) Planning

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The Basics of Long Term Care (ALTCS) Planning

What is ALTCS (Arizona Long-Term Care System)?

ALTCS is part of AHCCCS (Arizona Health Care Cost Containment System). ALTCS is the state program that administers the federal Medicaid program. The ALTCS program helps pay for long term care and acute care expenses for the elderly and disabled. There are three criteria that a person must meet in order to qualify for the ALTCS program: Medical, Income and Resources.

Medical: A person is administered a pre?admission screening (also known as a PAS evaluation) to determine if an applicant can perform their activities of daily living (ADL’s) on their own or if they are in need of assistance. Some of these activities include bathing, feeding, walking, toileting, dressing, etc…

Income: A single person’s gross income cannot exceed $2205. For a married couple, their combined income cannot exceed $4410. However, if those income caps are exceeded but is not enough to pay for care, it is possible to set up an “Income Only Trust” or “Miller Trust” and become eligible for ALTCS. 

Resources: A single person is allowed to have $2000 in countable resources. There are resources that are exempt, or not counted, including a house (with up to $500,000 in equity), a vehicle, some life insurance, burial plots, irrevocable funeral plans, all personal property and some other miscellaneous items. For a married couple, the well spouse is entitled to keep a Community Spouse Resource Allowance (“CSRA”) which is an amount of the countable resources which is calculated as one?half of the total assets, up to a maximum of $120,900. The process takes time and planning for eligibility is critical to ensure that person receives services in a timely manner. Our fim has years of experience in assisting families with determining if ALTCS is right for their situation and we can help in completing ALTCS applications.

What Services Does ALTCS Cover?

ALTCS covers everything from in-home care services to skilled nursing care, and everything in between. Since ALTCS is based on an HMO model of care, the in-home care companies, group homes, assisted living facilities and skilled nursing facilities need to have a contract with ALTCS in order for the customer to receive service. The current contracted providers for ALTCS are Bridgeway, Evercare and Mercy Care.

Once approved for ALTCS benefits, a case manager is assigned to each customer to create a health care plan specific to the customer’s needs. Customers can choose contracted health care providers through ALTCS if they would like to reduce their out-of-pocket costs.  ALTCS does not cover hospital stays, dental care or assisted devices such as eye glasses or walkers. It is recommended that ALTCS customers keep their Medicare and or supplemental health/dental insurance for this reason. 

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