The Arizona Long Term Care System (ALTCS) is Arizona’s Long-Term Care Medicaid program. The program covers day programs, some in home care, memory care centers, group homes, assisted living centers, nursing home care and many more services. The purpose of ALTCS is to ensure that people with limited income and assets combined with medical needs are able to be served all while making sure the spouses of such individuals do not become destitute.
Some people are unwilling to explore the availability of using ALTCS because of the fear of losing the home. There are usually two main concerns: the house will make my loved one ineligible for ALTCS or, the State will take the home when my loved one dies.
It is certainly true that to qualify for ALTCS the assets and income of the applicant must meet certain criteria. For a married couple where the spouse lives in the home, the house is an excluded resource regardless of the value of the home. The home must be the primary residence of the person receiving ALTCS. The home is also excluded from being considered a countable resource in these circumstances:
-The customer or spouse lives in the home property;
-The customer is absent from the home property due to institutionalization but the customer’s spouse or dependent relative lives in the property as his or her principle residence;
-The customer lived in the home property, is absent due to institutionalization, but intends to return to the home.
However, if the applicant is unmarried, the equity value of the home must not exceed $595,000 (2020) if it meets one of the criteria above. Additionally, while the property is for sale, it is also excluded. Although the rules might be confusing, in general, owning a residence is a not a reason to avoid using ALTCS services to help pay for care.
That brings us to the second concern i.e., the State will get the house upon the death of the ALTCS recipient. This can get complicated because ALTCS has an estate recovery program and lien rights. Under the estate recovery program, ALTCS only recovers property that is subject to a small estate affidavit or a probate. Therefore, a home owned with rights of survivorship and the survivor is living or where a beneficiary deed was recorded before the death of the ALTCS recipient, will avoid estate recovery.
ALTCS also has the right to file a lien against real property. However, if a spouse is alive, a lien will not be filed. Additionally, the State only has a right to file a lien against the real property if the ALTCS recipient was in a long-term care nursing home for 90 or more days with no intent to return home. There are some additional exemptions to these rules as well.
While the rules are confusing, it is always beneficial to investigate whether an ALTCS application is worth pursuing.
Written by: Emily B. Kile, Esq.