How ALTCS helps pay for assisted living

If you are reading about ALTCS, you are probably looking at years of care costs and wondering how long savings will last. ALTCS can make a real difference for families who qualify. It also has detailed rules that catch people out, especially around money that has been given away or moved. This guide explains, in plain terms, what ALTCS is, what it can and can’t pay for in assisted living, and how to get started.

Good to know: We are not ALTCS eligibility experts, and we don’t decide who qualifies. AHCCCS makes every eligibility decision. This guide is general information, and program rules and figures change. Check current details with AHCCCS, and talk to an elder law attorney before moving, selling or giving away assets.

What ALTCS is

ALTCS stands for the Arizona Long Term Care System. It is the part of AHCCCS, Arizona’s Medicaid program, that pays for long-term care services for people who need a nursing-facility level of care and meet its financial rules.

Many people assume ALTCS only pays for nursing homes. It doesn’t. ALTCS can pay for care in a nursing facility, at home, or in an assisted living setting, including many residential care homes. For a lot of families, that flexibility is the most important thing to understand.

What ALTCS pays for in assisted living

In assisted living, ALTCS generally pays for the care, not the room and board.

• Care means the hands-on help: bathing, dressing, toileting, medications, supervision and so on.
• Room and board means rent and meals. The resident usually pays this from their own income, such as Social Security or a pension.

On top of room and board, some residents also pay a monthly share of cost toward their care, based on their income. AHCCCS calculates this. When you add up what a place will cost under ALTCS, include all three: room and board, any share of cost, and anything the community charges that ALTCS doesn’t cover.

Not every assisted living community or residential care home accepts ALTCS. Those that do may have only a limited number of ALTCS spaces, and some only accept residents who have paid privately first. These are the questions to ask early.

Who may qualify

AHCCCS looks at two separate things. Someone has to meet both.

Medical need

The person must need the level of care usually provided in a nursing facility. AHCCCS decides this through an assessment called the Pre-Admission Screening, or PAS. An assessor reviews medical records and asks detailed questions about daily needs: mobility, transfers, bathing, dressing, eating, continence, memory and behavior.

Be honest and specific during the PAS. Describe the bad days, not just the good ones, and the help that is actually being given, including at night.

Finances

There are limits on monthly income and on countable resources, such as bank accounts and investments. Some things usually don’t count, such as a primary home in many situations, one vehicle and certain personal belongings. Married couples have extra protections for the spouse who continues to live at home. The exact limits change, so check the current figures with AHCCCS.

The person must also be an Arizona resident, meet citizenship or qualified immigration rules, and be 65 or older, or blind, or have a disability.

The five-year look-back

This is the rule that causes the most trouble. AHCCCS reviews assets that were given away or sold for less than they were worth during the five years before the application. Transfers in that window can lead to a period when ALTCS won’t pay for care.

Common examples include gifts to children or grandchildren, adding someone to a deed, or selling a house to a relative for less than market value. Families often make these moves with the best intentions. Talk to an elder law attorney before you move money, not after.

How to apply

1. Read the current rules on the AHCCCS website and see the ways to apply, which include applying online or contacting an ALTCS office.
2. Gather documents. Identification, proof of income, recent bank and investment statements, records of property and vehicles, insurance policies, and any power of attorney paperwork.
3. Submit the application. If someone is applying on behalf of a family member, they will need the right authority to do so.
4. Prepare for the PAS assessment. Have medication lists and recent medical records handy, and plan to be present if you can.
5. Respond quickly to any requests for more information. Delays in sending documents are a common reason applications take longer.

Applications can take time, often weeks and sometimes longer. Keep copies of everything you send.

Planning while an application is pending

If a move can’t wait, many families pay privately at first and switch to ALTCS once it is approved, if the community allows that. Before you sign anything, ask the community:

• Do you accept ALTCS, and do you have an ALTCS space available now or soon?
• If my loved one starts as private pay, can they stay once ALTCS is approved?
• What would the monthly cost to the family be under ALTCS?

Get the answers in writing. A place that can’t accept ALTCS later may mean a second move, which is hard on anyone and especially hard on someone with dementia.

Common questions

Does ALTCS pay for assisted living rent?

No. In assisted living, ALTCS generally covers the care, not room and board. The resident usually pays rent and meals from their own income, and may also owe a monthly share of cost toward their care, which AHCCCS works out.

Can you own a home and still qualify for ALTCS?

Often, yes. A primary home is frequently left out of countable resources, but the rules have conditions, they change, and they can affect what the state recovers from an estate later. Ask AHCCCS or an elder law attorney before you sell or transfer a home.

How long does an ALTCS application take?

It varies. Gathering records, the PAS assessment and any follow-up requests all take time, and slow paperwork is one of the most common reasons for delay. If a move can’t wait, read what changes when you move from private pay to ALTCS before you sign anything.

Does every assisted living community accept ALTCS?

No. Some don’t accept it at all, and those that do may only have a few ALTCS spaces. Ask directly, and ask whether someone who starts as private pay can stay once ALTCS is approved.

How we can help

We can tell you which communities and care homes on your shortlist accept ALTCS, whether they have space, and how they handle residents who move from private pay to ALTCS. We can also point you toward elder law attorneys and benefits help in the Valley, and help you find assisted living in the Phoenix area that fits the budget wherever in the Valley you need it. We don’t complete ALTCS applications or give legal or financial advice. Talk to us about what you are weighing.