Understanding the Arizona Long-Term Care System (ALTCS)
ALTCS, pronounced "ALL-Tecs," is the Arizona Health Care Cost Containment System's (AHCCCS) Medicaid program designed to provide long-term care services for individuals who are elderly (65 and older), physically disabled, or developmentally disabled. Unlike Medicare, which primarily covers acute, short-term medical needs, ALTCS is a needs-based program that offers comprehensive coverage for chronic care. The services provided through ALTCS can enable individuals to receive the care they need in a variety of settings, including their own homes, assisted living facilities, or nursing homes. The program is administered through contracted insurance companies, known as Program Contractors, which manage the care and services for eligible members.
The Dual Pillars of Eligibility: Financial and Medical
To qualify for ALTCS, applicants must satisfy a strict two-pronged eligibility test: they must be both financially and medically eligible. The medical assessment determines if the individual requires a nursing home level of care, while the financial review ensures they meet state-mandated income and resource limits. Failing to meet the criteria in either category will result in a denial of benefits. The specific monetary limits are updated annually, so it is important to verify the current figures.
Meeting the Financial Requirements (2025)
For 2025, the financial criteria for ALTCS are based on an applicant's income and countable resources. These limits vary depending on marital status.
Income Limits (2025)
- Single Applicant: A gross monthly income must be no more than $2,901.
- Married Applicant (one spouse applying): The applicant's gross monthly income must be no more than $2,901. The non-applicant spouse's income is not counted against the applicant.
- Married Applicants (both applying): The combined gross monthly income must be no more than $5,802.
- Income-Only Trust (Miller Trust): For individuals whose income exceeds the limit, a special trust can be established to hold the excess income, allowing them to still qualify. Professional legal guidance is highly recommended for setting up and managing a Miller Trust.
Resource Limits (2025)
Resources refer to assets that can be converted to cash, such as bank accounts, investments, and non-primary property.
- Single Applicant: Countable resources must not exceed $2,000.
- Married Applicant (one spouse applying): The rules are more complex. The "Community Spouse" (non-applicant spouse) is allowed to keep a certain amount of the couple's combined assets, known as the Community Spouse Resource Allowance (CSRA). In 2025, the CSRA limits range from $31,584 to $157,920.
- Married Applicants (both applying): Each spouse is typically limited to $2,000 in countable resources.
The Medical Qualification: Pre-Admission Screening (PAS)
To determine medical eligibility, AHCCCS conducts a Pre-Admission Screening (PAS), which includes an in-person or telephone assessment by a nurse or social worker. The evaluation assesses the applicant's ability to perform Activities of Daily Living (ADLs), cognitive status, and medical needs. Applicants must demonstrate a need for a "nursing home level of care," which is assessed by a point system. A total score of 60 or higher is required to meet the medical criteria. It is important to note that meeting this level of care does not mean the person must enter a nursing facility; services can be provided in other approved settings.
Exemption from Resource Limits: What is Non-Countable?
Fortunately, not all of an applicant's assets are counted towards the resource limits. The following are typically considered exempt:
- Primary Residence: The home where the applicant or their spouse lives, provided the equity interest does not exceed a certain value (e.g., $730,000 in 2024, subject to annual change).
- Vehicle: One vehicle of any value is exempt.
- Burial Arrangements: Irrevocable burial plans or funeral trusts, as well as burial plots, are exempt.
- Personal and Household Items: The value of personal belongings is generally not counted.
Comparison of Countable vs. Exempt Assets
| Countable Resources | Exempt Assets |
|---|---|
| Cash in bank accounts | Primary residence (with equity limit) |
| Non-exempt vehicles | One primary vehicle |
| Stocks, bonds, money markets | Irrevocable funeral trusts |
| Investments, retirement funds (like IRAs/401(k)s) | Burial plots |
| Real property not used as a primary residence | Personal and household belongings |
| Cash value of life insurance policies (over $1,500) | Term life insurance policies |
The Application Process for ALTCS
Applying for ALTCS can be a multi-step process that can take 60 to 90 days if done correctly. It's important to gather all necessary documentation, including financial statements, proof of residency, and medical records, before starting. You can start the process online through the Health-e-Arizona Plus portal or by calling ALTCS directly. After the initial application is submitted, you will undergo both the financial and medical evaluations. If approved, you will choose a Program Contractor to manage your care. You can find more information and access application forms on the official ALTCS website.
Conclusion
Qualifying for Arizona long-term care requires meeting specific and strict financial and medical eligibility criteria. The Arizona Long-Term Care System (ALTCS) is a vital Medicaid program for many Arizona residents who are elderly or disabled and need significant care. By understanding the income and resource limits, navigating the Pre-Admission Screening process, and utilizing asset protection strategies where necessary, individuals and families can effectively plan to secure the long-term care they need.
