The Medicaid program in Arizona is called AHCCCS (the Arizona Health Care Cost Containment System). AHCCCS is jointly federal and state funded and helps to support low-income individuals who are younger than 65 (though some who are older might be eligible). You might qualify for benefits through this program if you earn 138 percent of the FPL (Federal Poverty Level) or less. As of 2019, this is $35,535 for a household with four family members and $17,236 for an individual.
If you’re over 65, you’ll need to apply for Medicaid benefits through the ALTCS (Arizona Long Term Care System). Unlike other Medicaid services, which place a limit on how many participants can enroll, ALTCS offers benefits as an entitlement. In other words, if you meet the requirements for eligibility, you can access services.
The income and asset limits for ALTCS is can be tricky to navigate. We’ll go into detail on that soon, in addition to ways you can qualify even if you don’t meet the requirements.
Points to Keep in Mind on Medicaid Eligibility
- AHCCCS typically covers state residents who are younger than 65
- Residents who are older than 65 or disabled should apply for ALTCS
- If you have children, they may be entitled to Medicaid services, too
- The application processing period is usually between 60 and 90 days
- If you don’t meet the financial requirements for ALTCS, a lawyer might be able to help
AHCCCS for Arizona Residents
When you apply to receive AHCCCS benefits, an associate will review your application and help you figure out which Medicaid coverage is best for your situation. To qualify for AHCCCS, you usually must be younger than 65 (though you can be 65 or older if you’re the caretaker or parent of a child). You must be either on Medicare as a pregnant woman or caretaker/parent of a child or be ineligible for Medicare services. You also need to earn below a certain limit and be a citizen of the U.S. or a qualified noncitizen.
Income-based AHCCCS will count most of the unearned and earned income you have. Some income doesn’t count, though, such as Supplemental Security Income.
Medicaid for Disabled and Elderly Residents
ALTCS is a state Medicaid program that can help certain individuals afford their medical care. This system provides specifically for the long-term medical needs of qualifying disabled, blind, or aged residents in the state. This program pays for the services you require once you’ve already exhausted your savings. To qualify, you must undergo a financial assessment to determine whether you are able to cover the costs yourself. The next component is a functional assessment to determine your current medical state and care needs.
The financial eligibility requirements to receive ALTCS benefits can be complicated and will be affected by whether or not you’re married. As a single applicant, you can earn *$2,829 or less in monthly income to qualify. If you’re married and applying for benefits on your own, your income is limited to the same amount and your spouse’s income doesn’t count. If you and your spouse are applying for ALTCS together, you may not earn more than *$5,658 monthly.
If your income is higher than these numbers, don’t let that deter you from pursuing ALTCS services. You might still be able to qualify for benefits by using a Miller Trust. Like other trusts, this type of trust must be legally sound in order to be considered valid.
*Based on 2024 ALTCS rates
How Working With an Attorney Can Help
Getting approved for AHCCCS benefits can prove tricky for some people. Many residents are denied ALTCS benefits because they have too many resources to meet the eligibility requirements. Fortunately, this doesn’t mean that you can’t qualify later once you do. You may be able to get around being over the resource limit by “spending down” on your assets in order to meet the financial requirements.
However, the way you go about this is extremely important. Working with a lawyer can ensure that you spend down in the way that will increase your odds of approval.
FAQs on Medicaid in Arizona
Here are some common queries that applicants may have about Medicaid services in the state:
Q: Will I owe any costs if I get Medicaid services?
For most of your needed medical services, you’ll either cover a small copayment when you visit a medical professional or pay nothing. In most cases, you’ll just have to show your coverage card to prove you have Medicaid and the state will pay your doctor for the costs.
Q: Can I get coverage for my children’s medical needs?
Medicaid and a program called CHIP (the Children’s Health Insurance Program) work together to offer low-cost coverage to Arizona residents with children. If your income meets the eligibility requirements, your children can access these services. If you give birth while you’re covered by Medicaid, your child will also automatically be enrolled for the first year of their life.
Q: What factors can slow down the processing period for my application?
To qualify for the program, you must submit your application, which can take up to 90 days to get approved. Your application processing period might take longer than average if your income is too high for eligibility in the month you apply and the month after but might be low enough during the third month. If more proof is needed to determine your eligibility, or you request extra time to gather the necessary documents, your processing period might also be longer than 90 days.
What to Do if You Need Help
The Medicaid application process can be complex, and many applicants are denied coverage each year. Thankfully, even if you’ve been denied before, all hope is not lost. Give us a call so we can work with you to apply and give you a better shot at approval for AHCCCS benefits. We also might be able to help you appeal the decision if your application for help with medical coverage was previously denied. Speak with one of our Elder Law attorneys today.
Need Help Applying for ALTCS in Arizona?
If you need help setting up Medicaid, speaking with a lawyer is a good place to start. The application process itself can be complex and confusing, and making mistakes can set you back in attaining benefits and services. If your situation is complicated or you need help meeting the eligibility requirements, one of our attorneys can answer your questions.
Contact the JacksonWhite ALTCS team today at (480) 467-4337 and learn more your options for long term care.